PERMANENT PACING AFTER CARDIAC TRANSPLANTATION

Objective-To determine the need for long-term pacing and optimum mode of pacing in cardiac transplant recipients. Design-(a) A retrospective review of patient records. (b) A prospective study of pacemaker use b y 24 hour ambulatory electrocardiography before and after reprogrammin g to minimise use of pacemakers. Setting-Outpatient clinic, supra-regi onal cardiopulmonary transplant unit. Patients-All 21 patients at this centre who had received permanent pacemakers after cardiac transplant ation. 18 of 19 survivors completed the prospective part of the study. Main outcome measure-The presence of pacing during a 24 hour ambulato ry electrocardiographic recording (programming: 50 beats/min, rate sen sor inactivated). Results-21 of 191 (11%) recipients surviving one mon th or more received permanent pacemakers. The indication was sinus nod e dysfunction in 13 (62%) and atrioventricular (AV) block in eight (38 %). Patients who paced on follow up 12 lead electrocardiograms decline d from 38% at three months to 10% at three years after transplantation . After programming to 50 beats/min only five of 18 (28%) patients pac ed during a 24 hour ambulatory recording. Four of 11 (36%) recipients who received pacemakers for sinus node dysfunction paced compared with one of seven patients (14%) paced for AV block. No patient who had a pacemaker before the 16th day after operation continued to pace wherea s five of nine implanted later were used long-term. Conclusion-Only fi ve of 18 (28%) patients with pacemakers continued to pace long-term. C ontinued pacing was more common in those with persistent sinus node dy sfunction after the second week after operation but the need for long- term pacing was not predictable.