PERMANENT PACEMAKER USE AFTER CARDIAC TRANSPLANTATION - COMPLETING THE AUDIT CYCLE

Objective-To determine the effects of delaying permanent pacemaker imp lantation in cardiac transplant recipients from less than three weeks to three weeks or more post transplantation-a change prompted by an ea rlier audit. Design-Retrospective review of resting 12 lead electrocar diograms and prospective 24 hour ambulatory electrocardiograms. Compar ison of pacemaker usage before (period 1) and after (period 2) the pol icy change in November 1990. Setting-Outpatient department, supra-regi onal cardiopulmonary transplant unit.Patients-All 30 consecutive ortho topic cardiac transplant recipients who received a permanent pacemaker within one month of transplantation between May 1985 and August 1995. Main outcome measures-Presence of pacing on the 12 lead electrocardio gram and during 24 hour ambulatory electrocardiogram monitoring (pacem aker programmed to 50 beats per minute). Results-16/152 (10.5%) cardia c transplant recipients received permanent pacemakers in period 1 comp ared with 14/180 (7.8%) in period 2 (P = NS). Evidence of pacing was s een on 12 lead electrocardiograms at three months in 37.5% recipients in period 1 compared with 78.6% in period 2 (P = 0.03). At six months pacemaker usage had declined to 18.8% in period 1 and 35.7% in period 2 and at three years to 13.3% in period 1 and 40% in period 2 (P = NS for both). 21% patients in period 1 pa;ced on ambulatory 24 hour monit oring compared with 38.5% in period 2 (P = NS). Conclusions-Delaying p ermanent pacemaker implantation to three weeks or more after cardiac t ransplantation reduced the proportion of permanent pacemaker implantat ions, slightly but not significantly. There was a significant increase in permanent pacemaker usage at three months post transplantation wit h trends towards increased usage at later times, suggesting more appro priate selection of patients for permanent pacing.