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Mallidi HR, Bates M. Pacemaker Use Following Heart Transplantation. Ochsner J. 2017;17(1):20-24
Mallidi, H. R., & Bates, M. (2017). Pacemaker Use Following Heart Transplantation. The Ochsner journal, 17(1), 20-24.
Mallidi, Hari R, and Bates, Michael. "Pacemaker Use Following Heart Transplantation." The Ochsner journal vol. 17,1 (2017): 20-24.
Mallidi HR, Bates M. Pacemaker Use Following Heart Transplantation. Ochsner J. 2017;17(1):20-24. PMID: 28331443; PMCID: PMC5349631.
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Ochsner J. 2017;17(1):20-24.

Pacemaker Use Following Heart Transplantation.

The Ochsner journal

Hari R Mallidi, Michael Bates

Affiliations

  1. Department of Surgery, Harvard University, Cambridge, MA ; Department of Surgery, Harvard University, Cambridge, MA.
  2. Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA ; Department of Surgery, Harvard University, Cambridge, MA.

PMID: 28331443 PMCID: PMC5349631

Abstract

BACKGROUND: The incidence of permanent pacemaker implantation after orthotopic heart transplantation has been reported to be 2%-24%. Transplanted hearts usually exhibit sinus rhythm in the operating room following reperfusion, and most patients do not exhibit significant arrhythmias during the postoperative period. However, among the patients who do exhibit abnormalities, pacemakers may be implanted for early sinus node dysfunction but are rarely used after 6 months. Permanent pacing is often required for atrioventricular block. A different cohort of transplant patients presents later with bradycardia requiring pacemaker implantation, reported to occur in approximately 1.5% of patients. The objectives of this study were to investigate the indications for pacemaker implantation, compare the need for pacemakers following bicaval vs biatrial anastomosis, and examine the long-term outcomes of heart transplant patients who received pacemakers.

METHODS: For this retrospective, case-cohort, single-institution study, patients were identified from clinical research and administrative transplant databases. Information was supplemented with review of the medical records. Standard statistical techniques were used, with chi-square testing for categorical variables and the 2-tailed

RESULTS: Between January 1968 and February 2008, 1,450 heart transplants were performed at Stanford University. Eighty-four patients (5.8%) were identified as having had a pacemaker implanted. Of these patients, 65.5% (55) had the device implanted within 30 days of transplantation, and 34.5% (29) had late implantation. The mean survival of patients who had an early pacemaker implant was 6.4 years compared to 7.7 years for those with a late pacemaker implant (

CONCLUSION: Our results show a decreased pacemaker need after bicaval anastomosis and that more patients who needed a pacemaker after transplantation had a pretransplant diagnosis of ischemic cardiomyopathy. In our cohort, the need for a permanent pacemaker was also associated with older donor grafts and an increase in the number of treated rejection episodes.

Keywords: Heart transplantation; pacemaker-artificial; surgery

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