DECLINING NEED FOR PACEMAKER IMPLANTATION AFTER CARDIAC TRANSPLANTATION

The need for permanent pacemaker implantation was retrospectively revi ewed in 436 consecutive cardiac transplant recipients at our center be tween 1985 and 1998. The incidence of pacemaker implantation was exami ned in three arbitrarily defined periods: period 1, 1985-1990, before a review of pacemaker implantation policy; period 2, 1991-1995, after a change in policy to delay pacemaker implantation resulting from the review; and period 3, 1996-1998, after audit of this policy change, an d the introduction of a change in surgical technique, from the standar d atrial anastomosis to the bicaval anastomosis. Pacemaker implantatio n was not required in any recipient after the change in surgical techn ique, suggesting that the bicaval technique preserves sinus node funct ion much better than does the standard atrial anastomosis.