title: Permanent pacing after cardiac transplantation in the era of extended donors.
abstract: BACKGROUND
  Early results with bicaval anastomosis have shown a decreased requirement for permanent pacing (PPM) after transplantation (Tx). It is unclear whether this remains true in the current era of extended donor criteria. The objective of the present study was to characterize the need for post-Tx PPM requirements in the current bicaval era and to determine factors associated with need for pacing.
  
  
  METHODS
  The local cardiac Tx database, hospital records and electrophysiology laboratory database were cross-referenced for information on patients in the pre-, peri- and post-Tx period.
  
  
  RESULTS
  Between 2000 and 2004, 88 patients received a cardiac Tx using bicaval anastomosis. At post-Tx, 18 of 88 (20.5%) patients required a PPM. The incidence of single- and dual-chamber PPM was 31.3% and 68.7%, respectively. Mean donor age for patients requiring post-Tx PPM was 44.7 +/- 15.3 years compared with 35.7 +/- 14.4 years for those with no PPM requirement (p = 0.019). For every 5-year increase in donor age the risk for post-Tx PPM increased 1.234-fold (95% confidence interval [CI] 1.022 to 1.489, p = 0.0289). Recipient age, gender, amiodarone use, year of transplant, surgeon and surgical times were not associated with PPM requirements after cardiac Tx.
  
  
  CONCLUSIONS
  Pacing requirements after heart transplantation, in the era of extended donor criteria, exceed the previously published rates of 0% to 5%. The advantage of bicaval anastomosis in decreasing pacing needs post-Tx does not exist in the era of extended donor criteria, specifically in the older donor age group.
authors.affiliation: Division of Cardiology and Transplant, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Shelley
authors.initials: S
authors.lastname: Zieroth
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Diego H
authors.initials: DH
authors.lastname: Delgado
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cusimano
authors.forename: Mathura
authors.initials: M
authors.lastname: Thevarajah
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Cameron
authors.forename: Kumaraswamy
authors.initials: K
authors.lastname: Nanthakumar
mesh_terms: D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D046148:Donor Selection; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006321:Heart / Q000502:physiology*; D016027:Heart Transplantation / Q000379:methods* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014684:Venae Cavae / Q000601:surgery