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Sinus node dysfunction after heart transplantation—An analysis of risk factors and atrial pacing burden
Author(s) -
Herrmann Florian E. M.,
Wellmann Petra,
Sadoni Sebastian,
Schramm René,
Hagl Christian,
Juchem Gerd
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13202
Subject(s) - medicine , cardiology , heart transplantation , clamp , aortic cross clamp , transplantation , sinus (botany) , anastomosis , cohort , ischemia , sick sinus syndrome , atrial fibrillation , surgery , anesthesia , artery , mechanical engineering , clamping , botany , engineering , biology , genus
We investigated the development of sinus node dysfunction ( SND ) requiring pacemaker implantation after heart transplant ( HT x) especially regarding pacing burden in these patients. Patients and methods Patients requiring a pacemaker for SND were compared to all other patients in an HT x 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.