Pacemaker therapy for early and late sinus node dysfunction in orthotopic heart transplant recipients: a single-center experience

Abstract

Background: Sinus node dysfunction (SND) is a well-known early complication of orthotopic heart transplantation (OHT). Its incidence over the lifetime of transplant recipients is less well characterized. The goal of this study was to determine the incidence and timing of SND treated with a permanent pacemaker in a large cohort of OHT recipients.

Methods: The databases of the Yale University Heart Transplant and Electrophysiology Services were reviewed and cross referenced. Patients who received pacemakers for SND were identified for analysis. A total of 241 patients underwent OHT using biatrial anastamoses from 1984 to 2006. Two hundred sixteen patients, 149 men and 55 women, mean age 50.2 +/- 11.6 years, survived > 5 days post-OHT. These, minus 12 lost to follow-up, were included in the analysis.

Results: These 204 patients were followed in the Yale Heart Transplant Clinic and had yearly electrocardiograms and 24-hour ambulatory monitoring. Of these patients, 24 (four female, 20 male, mean age at transplant 49 +/- 12 years) were felt to have clinically significant SND and received a pacemaker. Fourteen patients received pacemakers within 30 days of OHT; 10 patients received pacemakers 45 to 4,329 days after OHT.

Conclusions: Although frequently seen as an early complication of OHT, SND remains a risk throughout the lifetime of OHT recipients. Its mechanism is likely multifactorial, and whether this risk can be mitigated over the long term by newer techniques such as bicaval anastamoses remains to be established.