CARDIAC-PACEMAKERS IN PEDIATRIC HEART-TRANSPLANT RECIPIENTS - INCIDENCE, INDICATIONS, AND ASSOCIATED FACTORS

This study was undertaken to assess the incidence, indications, and pr edisposing factors for pacemaker placement in a pediatric heart transp lant population. From November 1985 to May 1994, 246 pediatric patient s have undergone cardiac transplantation at Loma Linda University Medi cal Center. Seven (2.8%) have received pacemaker placement with an 8-5 0 month follow-up period. Median age at transplant was 462 days (0 day s to 2.5 years). The median time to pacemaker placement was 190 days ( 18-1,672 days) after transplantation. Indications were sick sinus synd rome (SSS) in 5 and heart block in 2 patients (1 during acute rejectio n). Three patients with SSS underwent electrophysiology studies (EPS); 1 was normal and 2 showed sin us node dysfunction. The mode of pacing was VVIR in 6 patients and WI in I patient. All 6 survivors are doing well and 5 patients' pacemakers still provide support. These 7 patien ts were compared with 185 pediatric patients (0 days to 12-years-old) transplanted during 1985 through 1993 who survived at least 6 months a fter 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 sig nificantly lower average heart rates in the first month after transpla ntation (108 +/- 16 vs 130 +/- 12; P = 0.0002). The need for permanent pacemakers in this population is uncommon. Pacemakers, however, can b e safely performed when necessary with excellent clinical results.