Key result
Sinus node dysfunction requiring a pacemaker after heart transplant was associated with a higher prevalence of biatrial anastomosis compared to patients without dysfunction (95.8% vs 90.0%, P=0.042).
Cohort (n=1,180)
Absolute Event Rate: 95.8% vs 90%
p-value: p=.042
Biatrial anastomosis and lower ratios of reperfusion time to ischemia and cross-clamp times are significant risk factors for sinus node dysfunction requiring long-term pacing after heart transplantation.
Biatrial anastomosis was associated with higher post-HTx SND risk; leaves open whether technique modification reduces pacemaker needs.
INTRODUCTION: We investigated the development of sinus node dysfunction (SND) requiring pacemaker implantation after heart transplant (HTx) especially regarding pacing burden in these patients. PATIENTS AND METHODS: Patients requiring a pacemaker for SND were compared to all other patients in an HTx cohort including transplant patients from 1981 to 2016. RESULTS: Sinus node dysfunction requiring pacemaker implantation developed in 118 patients (10%). These patients had received a biatrial anastomosis more frequently than those in the No SND group 95.8% vs 90.0% (P = .042). The ratio of reperfusion time to aortic cross-clamp time was significantly smaller in the SND group compared to the No SND group 71.7% vs 80.3% (P = .033). This also holds for the ratio of reperfusion time to ischemia time, which was 23.2% and 28.6%, respectively (P = .032). Pacing burden decreased from 90.5% to 66.3% after 2 years and remained around this value in the remaining 4 years of follow-up. CONCLUSION: We identified the biatrial anastomosis and a low ratio of reperfusion time to aortic cross-clamp time as well as to ischemia time as risk factors for SND requiring pacing. After implantation pacemakers continue to pace for over 60% of the time after 6 years.
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Herrmann et al. (2018) conducted a cohort in Heart transplantation (n=1,180). Sinus node dysfunction (SND) requiring pacemaker vs. No sinus node dysfunction was evaluated on Biatrial anastomosis (p=.042). Sinus node dysfunction requiring a pacemaker after heart transplant was associated with a higher prevalence of biatrial anastomosis compared to patients without dysfunction (95.8% vs 90.0%, P=0.042).
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