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Long‐Term Intrinsic Pacemaker Function in Patients Paced for Sinus Node Deficiency After Cardiac Transplantation
Author(s) -
HEINZ GOTTFRIED,
KRATOCHWILL CHRISTOPH,
BUXBAUM PETER,
KREINER GERHARD,
LAUFER GÜNTHER,
GÖSSINGER HEINZ,
LACZKOVICS AXEL
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb03022.x
Subject(s) - medicine , sinus (botany) , transplantation , sick sinus syndrome , ambulatory , sinus rhythm , bradycardia , cardiology , cardiac pacemaker , junctional rhythm , rhythm , heart transplantation , artificial cardiac pacemaker , anesthesia , surgery , heart rate , atrial fibrillation , blood pressure , botany , biology , genus
Fifteen cardiac transplant recipients requiring permanent pacing (AAJ, n = 9; VVI, n = 6; rate responsive devices, n = 11) for postoperative sinus node (SN) insufficiency underwent evaluation of long‐term SN function 240 to 1,461 days after transplantation. The intrinsic rhythm at the time of discharge was sinus in 7 patients; functional escape in 6 patients; and pacemaker dependent in 2 patients. At follow‐up, 5 patients had regained regular sinus rhythm, accounting for a total of 11 patients in sinus rhythm while 4 patients were in functional bradycardia. The SN recovery time as determined by the permanent pacemaker was normal (< 1,500 msec) in only 1/8 patients in whom it was determined, although 4 of these 8 patients were temporarily overriding the pacemaker during ambulatory monitoring. Patients with pathological SN recovery times included 3 patients with late return of sinus rhythm and 4 patients who had recovered normal sinus rhythm before their discharge from the hospital. Three patients developed late symptoms despite apparent early normalization and underwent delayed pacemaker implantations on postoperative days 35, 52, and 225, respectively. We conclude that, in patients requiring pacemaker implantation after cardiac transplantation, normalization of SN function cannot be inferred from just return of sinus rhythm, regardless of whether it occurs early or late. These findings may have implications when a pacemaker exchange or explanation is being considered.