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Sinus node dysfunction after orthotopic heart transplantation: the Vienna experience 1987-1993
G Heinz1, C Kratochwill, S Schmid
1Department of Cardiology, University Vienna, Austria.
Insights
The incidence of sinus node dysfunction after cardiac transplantation decreased over time. This decline was linked to the transplantation date, not patient or donor factors, indicating improved surgical outcomes.
Area of Science:
- Cardiology
- Transplant Surgery
- Electrophysiology
Background:
- Postoperative sinus node dysfunction is a known complication following cardiac transplantation.
- Understanding the incidence and trends of sinus node dysfunction is crucial for patient management.
Purpose of the Study:
- To determine the annual incidence and types of sinus node dysfunction after cardiac transplantation.
- To identify factors associated with the development of sinus node dysfunction post-transplant.
Main Methods:
- A 6 1/2-year observational study of 185 cardiac transplant recipients.
- Systematic annual assessment of sinus node function, including rhythm and corrected sinus node recovery time.
- Multivariate analysis to evaluate the impact of transplantation date, recipient/donor age, cardioplegia type, and ischemic time.
Main Results:
- Overall, 54 out of 185 patients (29.2%) experienced sinus node dysfunction, with 29 requiring pacemaker placement.
- The annual incidence of sinus node dysfunction significantly declined over the study period.
- The date of transplantation was the only significant factor associated with the occurrence of sinus node dysfunction.
Conclusions:
- The incidence of sinus node dysfunction following cardiac transplantation has decreased over time.
- Improvements in surgical techniques or perioperative care, reflected by the transplantation date, are likely responsible for this trend.
Abstract:
In the present study, the annual incidence of postoperative sinus node dysfunction and the type of sinus node abnormality after cardiac transplantation were followed over a 6 1/2-year period in 185 patients. Each year the sinus node function was systematically characterized by rhythm and corrected sinus node recovery time in a significant number of patients. Over the entire study period, there were 131 patients with normal sinus node function (corrected sinus node recovery time 318 +/- 55 msec) while 54 patients had latent (n = 24, sinus rhythm, corrected sinus node recovery time 8,053 +/- 2,198 msec) or manifest (n = 30, absence of sinus rhythm or pacemaker dependence) sinus node dysfunction. Twenty-nine patients had pacemaker placement. The incidence of sinus node dysfunction declined in absolute terms and when indexed by the actual number of patients transplanted per year (index 1987: 38.5; 1998: 17.6; 1989: 23.2; 1990: 29.1; 1991: 10.4; 1992: 7.5; 1993: 2.2). Among those with sinus node dysfunction, the annual percentage of patients presenting with prolonged recovery time, escape rhythm, and those reverting back to sinus rhythm until discharge did not change significantly over the study period (P = 0.22). On multivariate analysis, only the date of transplantation was significantly associated with the occurrence of postoperative sinus node deficiency (P = 0.0007) while age of recipient (P = 0.85) or donor (P = 0.96), the type of cardioplegia used (P = 0.09) and ischemic time (P = 0.09) were insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)