Sinus node dysfunction after orthotopic heart transplantation: the Vienna experience 1987-1993.
In the present study, the annual incidence of postoperative sinus node dysfunction and the type of sinus node abnormality after cardiac transplantation were followed over a 6 1/2-year period in 185 patients. Each year the sinus node function was systematically characterized by rhythm and corrected sinus node recovery time in a significant number of patients. Over the entire study period, there were 131 patients with normal sinus node function (corrected sinus node recovery time 318 +/- 55 msec) while 54 patients had latent (n = 24, sinus rhythm, corrected sinus node recovery time 8,053 +/- 2,198 msec) or manifest (n = 30, absence of sinus rhythm or pacemaker dependence) sinus node dysfunction. Twenty-nine patients had pacemaker placement. The incidence of sinus node dysfunction declined in absolute terms and when indexed by the actual number of patients transplanted per year (index 1987: 38.5; 1998: 17.6; 1989: 23.2; 1990: 29.1; 1991: 10.4; 1992: 7.5; 1993: 2.2). Among those with sinus node dysfunction, the annual percentage of patients presenting with prolonged recovery time, escape rhythm, and those reverting back to sinus rhythm until discharge did not change significantly over the study period (P = 0.22). On multivariate analysis, only the date of transplantation was significantly associated with the occurrence of postoperative sinus node deficiency (P = 0.0007) while age of recipient (P = 0.85) or donor (P = 0.96), the type of cardioplegia used (P = 0.09) and ischemic time (P = 0.09) were insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Cardiology, University Vienna, Austria.
G
G
Heinz
C
C
Kratochwill
S
S
Schmid
G
G
Kreiner
P
P
Siostrzonek
R
R
Pacher
M
M
Grimm
G
G
Laufer
H
H
Gössinger
D000328:Adult; D000367:Age Factors; D001146:Arrhythmia, Sinus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D012849:Sinoatrial Node / Q000503:physiopathology*; D014019:Tissue Donors