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Published on: December 11, 2017
Long-term results of pacemaker therapy after orthotopic heart transplantation
A Markewitz1, M Schmoeckel, G Nollert
1Department of Cardiac Surgery, University of Munich, Grosshadern Hospital, Bavaria, Germany.
Insights
Pacemaker implantation is necessary for 11% of heart transplant recipients due to bradyarrhythmias. Longer donor heart ischemic time predicted persistent pacing needs, impacting long-term survival rates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Electrophysiology
Background:
- Orthotopic heart transplantation (OHT) can lead to complications affecting heart rhythm.
- Bradyarrhythmias, particularly sinus node dysfunction, are a known complication post-OHT.
- The need for permanent pacing in OHT recipients requires further investigation.
Purpose of the Study:
- To identify indications for pacemaker implantation in OHT patients.
- To assess long-term survival rates in OHT recipients with pacemakers.
- To determine the persistence of bradyarrhythmias and predictive variables for pacemaker dependency.
Main Methods:
- Retrospective analysis of 237 OHT recipients from August 1981 to December 1991.
- Identification of patients requiring permanent pacemaker insertion for symptomatic bradyarrhythmia.
- Long-term follow-up including Holter monitoring and survival analysis.
Main Results:
- Twenty-six recipients (11%) required pacemakers for bradyarrhythmia (sinus node dysfunction or heart block).
- Actuarial survival at 1 and 4 years was 81% and 65%, comparable to non-pacemaker patients.
- Persistent bradyarrhythmias occurred in 24% at 3 months and 18% at 1 year; longer donor heart ischemic time predicted persistent pacing needs.
Conclusions:
- Pacemaker implantation is indicated in a subset of OHT recipients for symptomatic bradyarrhythmias.
- Long-term survival is not significantly compromised by pacemaker use post-OHT.
- Donor heart ischemic time is a significant predictor of persistent bradyarrhythmias requiring long-term pacing.
Abstract:
The objectives of this study were to identify: (1) the indications for pacemaker implantation; (2) the long-term survival; (3) the percentage of bradyarrhythmias below 50 beats/min persisting for more than 3 months; and (4) the variables predicting persistent bradyarrhythmias following orthotopic heart transplantations. During the recent decade (August 1, 1981 through December 31, 1991), 237 patients underwent orthotopic heart transplantation at our institution. Twenty-six recipients (11%) showed evidence of a symptomatic bradyarrhythmia due to sinus node dysfunction (n = 25) or complete heart block (n = 1), which required insertion of a permanent pacing device. During a mean follow-up period of 17.2 months (range 3 to 57 months), five patients (19%) died and one was lost to follow-up. Actuarial survival at 1 and 4 years were 81% and 65%, respectively, as compared to 79% and 69%, respectively, in patients without permanent pacemakers. Holter monitoring after 3 months (n = 25) and 1 year (n = 14) showed a spontaneous heart rate below 50 beats/min in six (24%) and three patients (18%), respectively. None of the tested variables predicted the necessity of initial pacemaker implantation. However, in patients requiring permanent pacing for a period longer than 3 months, ischemic time of the donor heart was found to be significantly longer as compared to the other patients (221 +/- 76 min vs 137 +/- 91 min, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
