[Sinus node syndrome after orthotopic heart transplantation]

Abstract

The sick sinus syndrome after cardiac transplantation is a new entity characterized by impaired automaticity (bradycardia, pathologic function tests, latent sinus node dysfunction) or entire lack of sinus activity (junctional escape mechanism), while the sinus node refractoriness and AV nodal function is usually unaffected. It may significantly affect quality of life after cardiac transplantation. Postoperative sinus node dysfunction is usually transient. However, patients in whom sinus rhythm has not been established by the fourth postoperative week should undergo pacemaker placement, given the unreliability of escape mechanisms in the denervated state. Patients with a latent type of sinus node dysfunction are likewise at risk of developing severe symptoms. These patients who usually are not prophylactically supplied with a pacemaker, may benefit from aminophylline therapy.