Permanent pacing after cardiac transplantation in the era of extended donors.
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.
Zieroth
Shelley
S
Division of Cardiology and Transplant, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Ross
Heather
H
Rao
Vivek
V
Delgado
Diego H
DH
Cusimano
Robert J
RJ
Thevarajah
Mathura
M
Cameron
Douglas A
DA
Nanthakumar
Kumaraswamy
K
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