title: Cardiac pacemakers in pediatric heart transplant recipients: incidence, indications, and associated factors. Pediatric Heart Transplant Group-Loma Linda.
abstract: This study was undertaken to assess the incidence, indications, and predisposing factors for pacemaker placement in a pediatric heart transplant population. From November 1985 to May 1994, 246 pediatric patients have undergone cardiac transplantation at Loma Linda University Medical Center. Seven (2.8%) have received pacemaker placement with an 8-50 month follow-up period. Median age at transplant was 462 days (0 days to 2.5 years). The median time to pacemaker placement was 190 days (18-1,672 days) after transplantation. Indications were sick sinus syndrome (SSS) in 5 and heart block in 2 patients (1 during acute rejection). Three patients with SSS underwent electrophysiology studies (EPS); 1 was normal and 2 showed sinus node dysfunction. The mode of pacing was VVIR in 6 patients and VVI in 1 patient. All 6 survivors are doing well and 5 patients' pacemakers still provide support. These 7 patients were compared with 185 pediatric patients (0 days to 12-years-old) transplanted during 1985 through 1993 who survived at least 6 months after transplantation. There was no correlation between the receipt of a pacemaker and graft cold ischemic time, rejection history, donor age, or recipient age at transplantation. The 5 patients with SSS had significantly lower average heart rates in the first month after transplantation (108 +/- 16 vs 130 +/- 12; P = 0.0002). The need for permanent pacemakers in this population is uncommon. Pacemakers, however, can be safely performed when necessary with excellent clinical results.
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, California, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Chinnock
authors.forename: V I
authors.initials: VI
authors.lastname: Torres
authors.forename: R V
authors.initials: RV
authors.lastname: Jutzy
authors.forename: J K
authors.initials: JK
authors.lastname: Johnston
authors.forename: R L
authors.initials: RL
authors.lastname: Larsen
authors.forename: A J
authors.initials: AJ
authors.lastname: Razzouk
authors.forename: M F
authors.initials: MF
authors.lastname: Baum
authors.forename: D L
authors.initials: DL
authors.lastname: Janner
mesh_terms: D016022:Case-Control Studies; D015984:Causality; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006084:Graft Rejection; D006327:Heart Block / Q000453:epidemiology / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012804:Sick Sinus Syndrome / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors