A comparison of VVIR and DDDR pacing following cardiac transplantation.
We compared the clinical course of patients paced in VVIR versus DDDR mode to determine the most appropriate method of pacing following cardiac transplantation. Pacemaker implantation was required in 9 of 90 orthotopic cardiac transplants (10%). Indications included sinus bradycardia or sinus arrest (8 patients) and AV node dysfunction (1 patient). VVIR pacemakers were implanted in four patients and DDDR in five patients. DDDR patients: The mean P wave was 1.7 mV and the mean atrial stimulation threshold was 0.8 V (at 0.5 msec). During follow-up of 20 months, two atrial lead complications developed (29% of leads in 33% of patients). No lead complications were directly related to endomyocardial biopsy. VVIR patients: All four patients developed VA conduction with mean VA time 180 msec (160-240 msec). Two patients developed pacemaker syndrome.


CONCLUSIONS
VA conduction and pacemaker syndrome may develop in cardiac transplant recipients paced in the VVIR mode. Dual chamber pacing is technically feasible and preferable following cardiac transplantation.
Cardiac Unit, Massachusettes General Hospital, Boston 02114.
M
M
Roelke
D
D
McNamara
S
S
Osswald
M
M
Semigran
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W
Dec
J W
JW
Harthorne
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011669:Pulmonary Wedge Pressure