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Stability of pacing indices and need for pacing in cardiac transplant patients over 1 year of follow-up

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Abstract

Background

A significant minority of cardiac transplant patients require permanent pacemaker (PPM) implant, primarily for sinus node dysfunction. The stability of pacing indices has not been determined in this unique patient population, and data regarding ongoing need for pacing are limited.

Methods

Pacing indices (sensing, threshold, and impedance) as well as the percentage of time patients required pacing were recorded, from 30 cardiac transplant patients that underwent PPM implant, over 1 year of follow-up. Repeated measure ANOVA (analysis of variance) was used to compare pacing indices and the percentage of time patients required pacing in each cardiac chamber (right atrium (RA) and right ventricle (RV)) and at different time points.

Results

There was no difference in sensing among the follow-up time points (p = 0.9). Thresholds at 3 months were significantly higher compared to the day of implant (p = 0.005) and the day after implant (p = 0.03). Impedances at implant were significantly higher compared to day 1 (p < 0.001), 3 months (p < 0.003), and 12 months (p < 0.001) post-implant. The mean percentage of RA pacing was 85 ± 6% the day after implant, 74 ± 6% at 3 months, and 80 ± 6% at 1 year (p = 0.17).

Conclusion

In cardiac transplant patients, pacing impedances decrease and thresholds trend up in short-term follow-up, but subsequent sensing, threshold, and impedance remain stable at 1 year. This is comparable to the pattern observed among noncardiac transplant PPM recipients. The atrial pacing percentage was stable over 1 year, suggesting continued relative sinus node dysfunction.

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References

  1. de Jonge N et al. Guidelines for heart transplantation. Neth Heart J. 2008;16(3):79–87.

    Article  PubMed  PubMed Central  Google Scholar 

  2. HRSA Scientific Registry of Transplant Receipients - 2011 Report; Available from http://optn.transplant.hrsa.gov/.

  3. Heinz G et al. Sinus node dysfunction after orthotopic cardiac transplantation: postoperative incidence and long-term implications. Pacing Clin Electrophysiol. 1992;15(5):731–7.

    Article  CAS  PubMed  Google Scholar 

  4. Heinz G et al. Demographic and perioperative factors associated with initial and prolonged sinus node dysfunction after orthotopic heart transplantation. The impact of ischemic time. Transplantation. 1991;51(6):1217–24.

    Article  CAS  PubMed  Google Scholar 

  5. Scott CD, Dark JH, McComb JM. Sinus node function after cardiac transplantation. J Am Coll Cardiol. 1994;24(5):1334–41.

    Article  CAS  PubMed  Google Scholar 

  6. Mackintosh AF et al. Sinus node function in first three weeks after cardiac transplantation. Br Heart J. 1982;48(6):584–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Schuchert A, Kuck KH, Bleifeld W. Stability of pacing threshold, impedance, and R wave amplitude at rest and during exercise. Pacing Clin Electrophysiol. 1990;13(12 Pt 1):1602–8.

    Article  CAS  PubMed  Google Scholar 

  8. Fischler H. Polarization properties of small-surface-area pacemaker electrodes--implications on reliability of sensing and pacing. Pacing Clin Electrophysiol. 1979;2(4):403–16.

    Article  CAS  PubMed  Google Scholar 

  9. de Buitleir M et al. Acute changes in pacing threshold and R- or P-wave amplitude during permanent pacemaker implantation. Am J Cardiol. 1990;65(15):999–1003.

    Article  PubMed  Google Scholar 

  10. Pickering JG, Boughner DR. Fibrosis in the transplanted heart and its relation to donor ischemic time. Assessment with polarized light microscopy and digital image analysis. Circulation. 1990;81(3):949–58.

    Article  CAS  PubMed  Google Scholar 

  11. Yamani MH et al. Myocardial ischemic-fibrotic injury after human heart transplantation is associated with increased progression of vasculopathy, decreased cellular rejection and poor long-term outcome. J Am Coll Cardiol. 2002;39(6):970–7.

    Article  PubMed  Google Scholar 

  12. Armstrong AT et al. Quantitative investigation of cardiomyocyte hypertrophy and myocardial fibrosis over 6 years after cardiac transplantation. J Am Coll Cardiol. 1998;32(3):704–10.

    Article  CAS  PubMed  Google Scholar 

  13. Wilson RF et al. Evidence for structural sympathetic reinnervation after orthotopic cardiac transplantation in humans. Circulation. 1991;83(4):1210–20.

    Article  CAS  PubMed  Google Scholar 

  14. Platia EV, Brinker JA. Time course of transvenous pacemaker stimulation impedance, capture threshold, and electrogram amplitude. Pacing Clin Electrophysiol. 1986;9(5):620–5.

    Article  CAS  PubMed  Google Scholar 

  15. Gupta PK et al. Appraisal of sinus nodal recovery time in patients with sick sinus syndrome. Am J Cardiol. 1974;34(3):265–70.

    Article  CAS  PubMed  Google Scholar 

  16. DiBiase A et al. Frequency and mechanism of bradycardia in cardiac transplant recipients and need for pacemakers. Am J Cardiol. 1991;67(16):1385–9.

    Article  CAS  PubMed  Google Scholar 

  17. Parry G et al. Declining need for pacemaker implantation after cardiac transplantation. Pacing Clin Electrophysiol. 1998;21(11 Pt 2):2350–2.

    Article  CAS  PubMed  Google Scholar 

  18. Heinz G et al. Sinus node dysfunction after orthotopic heart transplantation: the Vienna experience 1987-1993. Pacing Clin Electrophysiol. 1994;17(11 Pt 2):2057–63.

    Article  CAS  PubMed  Google Scholar 

  19. Morgan JA, Edwards NM. Orthotopic cardiac transplantation: comparison of outcome using biatrial, bicaval, and total techniques. J Card Surg. 2005;20(1):102–6.

    Article  PubMed  Google Scholar 

  20. Herre JM, Barnhart GR, Llano A. Cardiac pacemakers in the transplanted heart: short term with the biatrial anastomosis and unnecessary with the bicaval anastomosis. Curr Opin Cardiol. 2000;15(2):115–20.

    Article  CAS  PubMed  Google Scholar 

  21. Weiss ES et al. Outcomes in bicaval versus biatrial techniques in heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant. 2008;27(2):178–83.

    Article  PubMed  Google Scholar 

  22. Arrowood JA et al. Absence of parasympathetic control of heart rate after human orthotopic cardiac transplantation. Circulation. 1997;96(10):3492–8.

    Article  CAS  PubMed  Google Scholar 

  23. Savin WM et al. Cardiorespiratory responses of cardiac transplant patients to graded, symptom-limited exercise. Circulation. 1980;62(1):55–60.

    Article  CAS  PubMed  Google Scholar 

  24. Trento A et al. Clinical experience with one hundred consecutive patients undergoing orthotopic heart transplantation with bicaval and pulmonary venous anastomoses. J Thorac Cardiovasc Surg. 1996;112(6):1496–502. discussion 1502-3.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Missouri–Kansas City (UMKC) School of Medicine, Kansas City, MO, USA

    Talha A. Farid, Mohamed A. Omer, Ashley Moser, Bethany Austin, Anthony Magalski & Alan P. Wimmer

  2. Department of Cardiovascular Medicine, University of Louisville, 201 Abraham Flexner Way, Louisville, KY, 40292, USA

    Talha A. Farid

  3. St. Luke’s Mid America Heart Institute, Kansas City, MO, USA

    Kensey Gosch, Ashley Moser, Bethany Austin, Anthony Magalski & Alan P. Wimmer

Authors
  1. Talha A. Farid
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  2. Mohamed A. Omer
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  3. Kensey Gosch
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  4. Ashley Moser
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  5. Bethany Austin
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  6. Anthony Magalski
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  7. Alan P. Wimmer
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Correspondence to Talha A. Farid.

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The authors declare that they have no conflict of interest.

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Ethical approval

The study conformed to the Helsinki Declaration of the World Medical Association. Saint Luke’s Mid America Heart Institute’s ethics review board approved the study protocol.

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Farid, T.A., Omer, M.A., Gosch, K. et al. Stability of pacing indices and need for pacing in cardiac transplant patients over 1 year of follow-up. J Interv Card Electrophysiol 49, 27–32 (2017). https://doi.org/10.1007/s10840-017-0226-x

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  • DOI: https://doi.org/10.1007/s10840-017-0226-x

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