Terbutaline for sinus node dysfunction after heart transplantation

Early sinus node dysfunction (SND) occurs in 2%-4% of patients following heart transplantation (HT).

The purpose of the current study was to examine characteristics of patients requiring terbutaline for SND post-HT and clinical and hemodynamic outcomes.

A retrospective study was conducted at 2 centers to identify HT recipients from January 2020 to June 2025 started on terbutaline for early SND. Data was collected regarding recipient and donor characteristics and compared between terbutaline and no terbutaline groups. For the terbutaline group, additional information was obtained regarding changes in hemodynamics, dosing, and tolerability. Response to terbutaline after steady-state dosing and sinus node recovery were assessed.

450 individuals underwent bicaval HT (median age 56 years, 75% male, 23% black, 18% Hispanic). Of these, 30 (6.7%) were initiated on terbutaline an average of 7 days post-HT. Demographics, pre-transplant mechanical circulatory support, or pre-transplant amiodarone exposure were similar between groups. Older donor age, longer ischemic time, and Organ Care System use were significantly associated with terbutaline use. Heart rate and cardiac index by Fick significantly increased after starting terbutaline with significant individual variability. 50% were classified as having sinus node recovery; 2 patients ultimately needed a permanent pacemaker.

Despite individual variability in heart rate response with terbutaline, early SND was able to be managed pharmacologically in most patients and need for permanent pacemaker remained low.