Permanent Atrial Pacing in Cardiac Transplant Patients

Abstract

Thirteen out of 223 consecutive cardiac transplant patients required permanent pacemaker implantation; 11 for sinus node dysfunction and 2 for complete AV block. Patients with sinus node dysfunction were considered for AAIR mode pacemakers if they had intact AV conduction defined as a Wenckebach point of > 120 beats/min. Ten of 11 patients with sinus node dysfunction had a single atrial lead placed. Atrial lead placement was most easily accomplished with a straight, active fixation lead and the use of manually curved stylets to find an optimal position in the donor atrium, although active fixation leads with a preformed atrial J were used as well. Two leads dislodged requiring revision. In contrast, only 1 of 250 atrial leads implanted in nontransplanted hearts dislodged (P < 0.0001). Transvenous endomyocardial biopsies have not caused atrial lead dislodgment. Most transplant recipients requiring permanent pacing have intact AV nodal function and require only atrial pacing. Atrial lead dislodgment requiring lead revision occurs more frequently in heart transplant recipients than in native hearts. Use of a straight active fixation lead with a manually formed curve in the stylet is useful in order to find the optimal position for pacing.

Pacemaker Therapy for Early and Late Sinus Node Dysfunction in Orthotopic Heart Transplant Recipients: A Single‐Center Experience

“…Rothman et al noted a similar incidence of SND (42%) in the early postoperative period (defined by nonsinus rhythm on monitoring or the presence of an abnormal sinus node recovery time or secondary pauses when patients were tested in the electrophysiology laboratory) 14 . Early permanent pacemaker implantation rates vary from 2.8% to 29% in different series 1,6, 9,10,15–22 . Our incidence of SND resulting in permanent pacing within the first 30 days is 6.8%, a finding similar to these previously reported results.…”

Permanent Pacing for Late‐Onset Atrioventricular Block in Patients with Heart Transplantation: A Single Center Experience

“…Finally, we are cautious about drawing conclusions about survival in patients with late‐onset AV block due to the small number of patients in this study. Nonetheless, our data are consistent with previous reports, suggesting no effect on long‐term survival in patients with late‐onset AV block requiring permanent pacemaker 6,8,9,17,18 …”

“…Some studies suggested late‐onset SND and others AV block as the dominant indication for permanent pacing, although the number of patients were generally small (Table III). 4 , 7–11 , 13–16 This study, with 27 patients who required permanent pacing >3 months from heart transplant (13 [48.2%] due to SND and 14 [51.8%] due to AV block) add to these previous reports and suggest that both SND and AV block may contribute equally to the need for permanent pacing late after heart transplantation.…”

“…Our data are consistent with other studies of late‐onset heart block in orthotopic transplantation (ranging from 1.0% to 3.2%), with time to permanent pacemaker implantation ranging from 6 to 122 months (Table III). 4 , 6–14 …”

“…Our data are consistent with other studies of late-onset heart block in orthotopic transplantation (ranging from 1.0% to 3.2%), with time to permanent pacemaker implantation ranging from 6 to 122 months (Table III). 4,[6][7][8][9][10][11][12][13][14] Some studies suggested late-onset SND and others AV block as the dominant indication for permanent pacing, although the number of patients were generally small (Table III). 4,[7][8][9][10][11][13][14][15][16] This study, with 27 patients who required permanent pacing >3 months from heart transplant (13 [48.2%] due to SND and 14 [51.8%] due to AV block) add to these previous reports and suggest that both SND and AV block may contribute equally to the need for permanent pacing late after heart transplantation.…”