Permanent pacemaker for rejection episodes after heart transplantation: a poor prognostic sign.
BACKGROUND
The development of arrhythmias early or late after heart transplantation has been associated with acute and chronic rejection. This study aims to document the importance of this relationship and its value as a prognostic sign in those patients who required a permanent pacemaker for rejection episodes.


METHODS
A retrospective analysis of 158 orthotopic heart transplantations performed in 157 patients between December 1988 and April 1995 was done. The clinical course and the outcome of 6 patients who underwent insertion of a permanent pacemaker for bradyarrhythmias caused by acute or chronic allograft rejection were compared with the course and outcome of 9 patients who had pacemaker placement as a result of sinus node dysfunction not associated with rejection.


RESULTS
The mortality rate was 100% for patients whose indication for permanent pacing was severe acute or chronic rejection. Conversely, 8 of the 9 patients who underwent pacemaker placement for sinus node dysfunction not associated with rejection are long-term survivors; the one late death was due to a noncardiac cause.


CONCLUSIONS
We observed a strong relationship between bradyarrhythmias requiring a permanent pacemaker and severe acute or chronic allograft rejection. This association suggests a poor prognosis and indicates that these patients should be managed aggressively. Such management includes close immunologic surveillance for cellular and humoral rejection, increased frequency of endomyocardial biopsies and coronary angiography, and early consideration for retransplantation.
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
C
C
Blanche
L S
LS
Czer
M C
MC
Fishbein
J J
JJ
Takkenberg
A
A
Trento
D000208:Acute Disease; D000328:Adult; D001919:Bradycardia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection / Q000150:complications* / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011379:Prognosis; D012189:Retrospective Studies; D013616:Tachycardia, Sinus / Q000209:etiology / Q000628:therapy