Key Points
- To determine the long-term requirement for pacing and the optimal pacing mode in heart transplant recipients.
- Retrospective chart review of 21 heart transplant recipients who received permanent pacemakers at a single supra-regional cardiopulmonary transplant center.
- Prospective study of 18 surviving recipients evaluating pacemaker dependency via 24-hour ambulatory electrocardiography after reprogramming devices to 50 beats/min with rate sensors inactivated.
- Permanent pacemakers were implanted in 21 of 191 recipients (11%) surviving at least one month, indicated for sinus node dysfunction in 62% (n=13) and atrioventricular block in 38% (n=8).
- Pacing on follow-up 12-lead ECGs decreased from 38% at 3 months to 10% at 3 years post-transplant, and only 5 of 18 patients (28%) continued pacing during 24-hour ambulatory recording after device reprogramming.
- Long-term pacing occurred in 4 of 11 patients (36%) implanted for sinus node dysfunction versus 1 of 7 (14%) for atrioventricular block; 0 of the patients implanted before postoperative day 16 required long-term pacing compared to 5 of 9 implanted later.
Structured PICO
What is the true need for long-term pacing in cardiac transplant recipients who receive permanent pacemakers?
PPopulation21 patients who received permanent pacemakers after cardiac transplantation (out of 191 recipients surviving ≥1 month). 18 completed the prospective study.
IInterventionReprogramming pacemakers to 50 beats/min with rate sensor inactivated
OOutcomeThe presence of pacing during a 24 hour ambulatory electrocardiographic recordingsurrogate
Only a minority of cardiac transplant recipients who receive permanent pacemakers require long-term pacing, particularly if implanted before the 16th postoperative day.