title: Long-term pacing in heart transplant recipients is usually unnecessary.
abstract: The indications for and timing of permanent pacing were reviewed in all 17 of 154 adult heart transplant recipients at this center who have had permanent pacemakers implanted. Resting 12-lead ECGs recorded during routine follow-up were examined. A prospective study of pacing requirement was then undertaken. Holter monitoring was performed before and after reprogramming the pacemakers to VVI mode at 50 beats/min. Exercise responses in various pacing modes were then assessed in seven patients with rate responsive pacemakers using a standard Bruce protocol treadmill test. The indication for pacing was sinus node dysfunction in 59% (10/17) and atrioventricular (AV) block in 41% (7/17). The majority of pacemakers were implanted between seven and 21 days after transplantation. There was a progressive reduction in the frequency of pacing on 12-lead ECGs with time after transplantation. There was a progressive reduction in the frequency of pacing on 12-lead ECGs with time after transplantation. Eight of 14 patients with empirically selected programming paced during Holter monitoring. After reprogramming to 50 beats/min VVI mode only three of 14 patients, all with sinus node dysfunction, paced. Rate responsive pacing made no difference to exercise time. The requirement for long-term pacing in cardiac transplant recipients is small (3/154) and is limited to patients with sinus node dysfunction. Rate responsive pacing did not increase exercise tolerance.
authors.affiliation: Cardiothoracic Centre, Freeman Hospital Newcastle upon Tyne, United Kingdom.
authors.forename: C D
authors.initials: CD
authors.lastname: Scott
authors.forename: I
authors.initials: I
authors.lastname: Omar
authors.forename: J M
authors.initials: JM
authors.lastname: McComb
authors.forename: J H
authors.initials: JH
authors.lastname: Dark
authors.forename: R S
authors.initials: RS
authors.lastname: Bexton
mesh_terms: D000328:Adult; D001146:Arrhythmia, Sinus / Q000453:epidemiology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006327:Heart Block / Q000453:epidemiology / Q000628:therapy*; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors