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Posttransplant pacemaker placement: case series and review.

Mark A Thompson¹, Hamang Patel

¹Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA.

Ochsner Journal

|May 24, 2011

Summary

Sinus node dysfunction after heart transplant can cause serious issues. Dual-lead atrial pacing in both donor and recipient atria significantly improves heart rate variability and restores chronotropic competence in transplant patients.

Keywords:

Chronotropic incompetence dual-atrial pacing orthotopic heart transplantation permanent pacemaker sinus node dysfunction

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Area of Science:

Cardiology
Transplant Surgery
Biomedical Engineering

Background:

Sinus node dysfunction (SND) is a complication of orthotopic heart transplantation, leading to bradycardia, heart block, and syncope.
SND affects 6%-23% of heart transplant recipients, often necessitating pacemaker implantation.

Purpose of the Study:

To evaluate the effectiveness of different pacemaker lead placement techniques in heart transplant recipients.
To assess the impact of lead placement on heart rate variability and chronotropic competence.

Main Methods:

Analysis of permanent pacemaker implantations in orthotopic heart transplant patients between January 2002 and October 2008.
Comparison of three lead placement techniques: dual-chamber (donor atrium/ventricle), single lead (donor atrium), and dual leads (donor and recipient atria).
Assessment of heart rate variability using paced histograms.

Main Results:

Dual leads in both donor and recipient atria (A(R)-A(D)) demonstrated the highest heart rate variability (97%).
Single donor atrium lead (A(D)) showed 35% variability, while dual-chamber pacing (A(D)-V(D)) showed 14% variability.
The A(R)-A(D) technique was used in 25% of cases, A(D)-V(D) in 62.5%, and A(D) in 12.5%.

Conclusions:

Orthotopic heart transplantation results in autonomic denervation and chronotropic incompetence.
Atrial pacing, particularly with dual leads in both atria, can restore chronotropic competence and improve exercise capacity.
This technique offers rate responsiveness for heart transplant recipients experiencing SND.