Adjunctive Cilostazol Therapy for Sinus Node Dysfunction After Heart Transplantation

BACKGROUND: Adjunctive therapy with cilostazol, a phosphodiesterase-3 inhibitor, for sinus node dysfunction (SND) after heart transplantation (HTx) remains unestablished. CASE SUMMARY: We report the case of a 33-year-old woman who developed an atrioventricular junctional rhythm after HTx. Her SND had persisted for more than 3 weeks post-HTx despite treatment with positive chronotropic agents, including isoproterenol and tulobuterol. After the initiation of off-label cilostazol, her heart rate gradually increased. She was discharged without requiring permanent pacemaker implantation. DISCUSSION: -adrenergic agonist in a patient with atrioventricular junctional rhythm after HTx. In our case, the addition of cilostazol appeared to improve right ventricular function and cardiac index by increasing the heart rate without adverse events. TAKE-HOME MESSAGE: Cilostazol may represent an adjunctive option for managing severe SND in heart transplant recipients.