Experience on temporary and permanent cardiac pacing after heart transplantation

Abstract

Objectives: To evaluate and summarize the indications and outcome of cardiac pacing after heart transplantation.

Methods: We reviewed a total of 19 cases who received orthotopic heart transplantation with biatrial anastomosis at our hospital since 1997. Data of cases who received temporary or permanent cardiac pacing due to bradyarrhythmias during both perioperative and follow-up periods.

Results: Nine cases received temporary cardiac pacing after heart transplantation. In addition, seven of these cases received temporary cardiac pacing during the perioperative period most of them spontaneously recovered. Two cases received temporary cardiac pacing at late stage post-surgery after discontinuance of anti-rejection drugs, and died because of cardiac function deterioration during hospitalization. Four cases received permanent cardiac pacing, three at late stage post-surgery, another during perioperative period. All three cases received implantation of a dual-chamber pacemaker via conventional approach. After pacemaker implantation, patients were followed up for 6 months to 11 years, and parameters were all within the normal range. Two cases underwent device replacement because of battery exhaustion. Another patient developed infective endocarditis and secondary multi-organ failure after pacemaker implantation and didn’t survive.

Conclusions: After orthotopic heart transplantation with biatrial anastomosis, the occurrence of bradyarrhythmia is higher during the perioperative period, which indicates the need for temporary cardiac pacing. A considerable number of cases will require cardiac pacing at the late stage post-implantation. Furthermore, bradycardia with severe heart failure may indicate signs of graft rejection.