Late pacemaker requirement after pediatric orthotopic heart transplantation may predict the presence of transplant coronary artery disease
Background: Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation...
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Published in | The Journal of heart and lung transplantation Vol. 23; no. 1; pp. 67 - 71 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
2004
Elsevier Science |
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Abstract | Background: Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation.
Methods: We performed a retrospective study of all patients undergoing orthotopic heart transplantation at our institution from October 1984 to March 2001. Data obtained included demographics, indications for pacemaker, presence of transplant coronary artery disease and long-term follow-up. Patients were divided into: Group 1, patients requiring a pacemaker within 3 months of transplantation; and Group 2, patients requiring a pacemaker beyond 3 months.
Results: Pacemakers were required in 7 of 106 (6.6%) transplant recipients. Pacing indications for patients in Group 1 (
n = 2) were persistent bradycardia with pause-related ventricular arrhythmia and atrial flutter with resultant sinus pauses of up to 4 seconds. In Group 2 patients (
n = 5), indications for pacing were high-grade atrioventricular (AV) block in 1 patient and episodic sinus pauses up to 3.3 seconds associated with syncope/dizziness in the remaining 4 patients. All patients in Group 2 had transplant coronary disease diagnosed within 1 year of pacemaker implantation. All had resolution of symptoms and no complications after implantation.
Conclusions: Pacemakers are infrequently required after cardiac transplantation in children. Despite not meeting classic symptomatic sinus bradycardia criteria, pacemaker placement should be considered post-transplantation in patients with episodic sinus pauses and dizziness or syncope. Patients who present with the aforementioned symptoms or high-grade AV block should be evaluated closely for the presence or development of transplant coronary artery disease, as it may be their first symptom. |
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AbstractList | Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation.
We performed a retrospective study of all patients undergoing orthotopic heart transplantation at our institution from October 1984 to March 2001. Data obtained included demographics, indications for pacemaker, presence of transplant coronary artery disease and long-term follow-up. Patients were divided into: Group 1, patients requiring a pacemaker within 3 months of transplantation; and Group 2, patients requiring a pacemaker beyond 3 months.
Pacemakers were required in 7 of 106 (6.6%) transplant recipients. Pacing indications for patients in Group 1 (n = 2) were persistent bradycardia with pause-related ventricular arrhythmia and atrial flutter with resultant sinus pauses of up to 4 seconds. In Group 2 patients (n = 5), indications for pacing were high-grade atrioventricular (AV) block in 1 patient and episodic sinus pauses up to 3.3 seconds associated with syncope/dizziness in the remaining 4 patients. All patients in Group 2 had transplant coronary disease diagnosed within 1 year of pacemaker implantation. All had resolution of symptoms and no complications after implantation.
Pacemakers are infrequently required after cardiac transplantation in children. Despite not meeting classic symptomatic sinus bradycardia criteria, pacemaker placement should be considered post-transplantation in patients with episodic sinus pauses and dizziness or syncope. Patients who present with the aforementioned symptoms or high-grade AV block should be evaluated closely for the presence or development of transplant coronary artery disease, as it may be their first symptom. BACKGROUNDFew data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation.METHODSWe performed a retrospective study of all patients undergoing orthotopic heart transplantation at our institution from October 1984 to March 2001. Data obtained included demographics, indications for pacemaker, presence of transplant coronary artery disease and long-term follow-up. Patients were divided into: Group 1, patients requiring a pacemaker within 3 months of transplantation; and Group 2, patients requiring a pacemaker beyond 3 months.RESULTSPacemakers were required in 7 of 106 (6.6%) transplant recipients. Pacing indications for patients in Group 1 (n = 2) were persistent bradycardia with pause-related ventricular arrhythmia and atrial flutter with resultant sinus pauses of up to 4 seconds. In Group 2 patients (n = 5), indications for pacing were high-grade atrioventricular (AV) block in 1 patient and episodic sinus pauses up to 3.3 seconds associated with syncope/dizziness in the remaining 4 patients. All patients in Group 2 had transplant coronary disease diagnosed within 1 year of pacemaker implantation. All had resolution of symptoms and no complications after implantation.CONCLUSIONSPacemakers are infrequently required after cardiac transplantation in children. Despite not meeting classic symptomatic sinus bradycardia criteria, pacemaker placement should be considered post-transplantation in patients with episodic sinus pauses and dizziness or syncope. Patients who present with the aforementioned symptoms or high-grade AV block should be evaluated closely for the presence or development of transplant coronary artery disease, as it may be their first symptom. Background: Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the incidence, indications and associations with regard to pacemaker placement in children who have undergone orthotopic heart transplantation. Methods: We performed a retrospective study of all patients undergoing orthotopic heart transplantation at our institution from October 1984 to March 2001. Data obtained included demographics, indications for pacemaker, presence of transplant coronary artery disease and long-term follow-up. Patients were divided into: Group 1, patients requiring a pacemaker within 3 months of transplantation; and Group 2, patients requiring a pacemaker beyond 3 months. Results: Pacemakers were required in 7 of 106 (6.6%) transplant recipients. Pacing indications for patients in Group 1 ( n = 2) were persistent bradycardia with pause-related ventricular arrhythmia and atrial flutter with resultant sinus pauses of up to 4 seconds. In Group 2 patients ( n = 5), indications for pacing were high-grade atrioventricular (AV) block in 1 patient and episodic sinus pauses up to 3.3 seconds associated with syncope/dizziness in the remaining 4 patients. All patients in Group 2 had transplant coronary disease diagnosed within 1 year of pacemaker implantation. All had resolution of symptoms and no complications after implantation. Conclusions: Pacemakers are infrequently required after cardiac transplantation in children. Despite not meeting classic symptomatic sinus bradycardia criteria, pacemaker placement should be considered post-transplantation in patients with episodic sinus pauses and dizziness or syncope. Patients who present with the aforementioned symptoms or high-grade AV block should be evaluated closely for the presence or development of transplant coronary artery disease, as it may be their first symptom. |
Author | Fenrich, Arnold L Friedman, Richard A Kertesz, Naomi J Cannon, Bryan C Denfield, Susan W Towbin, Jeffrey A Dreyer, W.Jeffrey |
Author_xml | – sequence: 1 givenname: Bryan C surname: Cannon fullname: Cannon, Bryan C email: bcannon@bcm.tmc.edu organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 2 givenname: Susan W surname: Denfield fullname: Denfield, Susan W organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 3 givenname: Richard A surname: Friedman fullname: Friedman, Richard A organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 4 givenname: Arnold L surname: Fenrich fullname: Fenrich, Arnold L organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 5 givenname: W.Jeffrey surname: Dreyer fullname: Dreyer, W.Jeffrey organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 6 givenname: Jeffrey A surname: Towbin fullname: Towbin, Jeffrey A organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA – sequence: 7 givenname: Naomi J surname: Kertesz fullname: Kertesz, Naomi J organization: Division of Cardiology, Section of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA |
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CitedBy_id | crossref_primary_10_1016_j_cardfail_2005_02_005 crossref_primary_10_1016_j_healun_2005_03_013 crossref_primary_10_1111_petr_13094 crossref_primary_10_1016_j_hrthm_2021_07_051 crossref_primary_10_1016_j_jacep_2021_07_009 crossref_primary_10_1111_petr_13698 crossref_primary_10_1016_j_hrthm_2015_04_045 crossref_primary_10_1111_ctr_13503 crossref_primary_10_3349_ymj_2019_60_5_423 crossref_primary_10_1016_j_ipej_2021_07_006 crossref_primary_10_1016_j_ipej_2021_07_005 crossref_primary_10_1017_S1047951121003395 crossref_primary_10_1111_petr_12832 crossref_primary_10_1111_petr_13206 crossref_primary_10_3390_jcdd11040099 crossref_primary_10_1017_S1047951121003413 crossref_primary_10_1016_j_healun_2011_05_010 crossref_primary_10_1111_j_1747_0803_2012_00656_x crossref_primary_10_1111_pace_13276 crossref_primary_10_1016_j_hrthm_2021_07_038 crossref_primary_10_1111_j_1747_0803_2009_00257_x |
Cites_doi | 10.1111/j.1540-8159.1998.tb01180.x 10.1111/j.1540-8159.1997.tb06077.x 10.1016/0003-4975(95)00612-O 10.1111/j.1540-8159.1996.tb04787.x 10.1590/S0066-782X2000000100002 |
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Keywords | Human Heart Graft(material) Pediatrics Late Instrumentation therapy Cardiovascular disease Infant Homotransplantation Coronary heart disease Instrumental stimulation Requirement Orthotopic transplantation Pacemaker Surgery Graft Circulatory system Child |
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References | Gullestad, Ross, Myers, Hoang (BIB6) 1997; 11 Chinnock, Torres, Jutzy (BIB3) 1996; 19 Woodard, Conti, Mills, Williams, Curtis (BIB2) 1997; 20 Parry, Holt, Dark, McComb (BIB4) 1998; 21 Bacal, Bocchi, Vieira (BIB1) 2000; 74 Blanche, Czer, Fishbein, Takkenberg, Trento (BIB5) 1995; 60 Grinstead, Smart, Pratt (BIB7) 1991; 10 Grinstead (10.1016/S1053-2498(03)00058-5_BIB7) 1991; 10 Gullestad (10.1016/S1053-2498(03)00058-5_BIB6) 1997; 11 Chinnock (10.1016/S1053-2498(03)00058-5_BIB3) 1996; 19 Bacal (10.1016/S1053-2498(03)00058-5_BIB1) 2000; 74 Woodard (10.1016/S1053-2498(03)00058-5_BIB2) 1997; 20 Blanche (10.1016/S1053-2498(03)00058-5_BIB5) 1995; 60 Parry (10.1016/S1053-2498(03)00058-5_BIB4) 1998; 21 |
References_xml | – volume: 60 start-page: 1263 year: 1995 end-page: 1266 ident: BIB5 article-title: Permanent pacemaker for rejection episodes after heart transplantation publication-title: Ann Thorac Surg contributor: fullname: Trento – volume: 21 start-page: 2350 year: 1998 end-page: 2352 ident: BIB4 article-title: Declining need for pacemaker implantation after cardiac transplantation publication-title: Pacing Clin Electrophysiol contributor: fullname: McComb – volume: 74 start-page: 5 year: 2000 end-page: 12 ident: BIB1 article-title: Permanent and temporary pacemaker implantation after orthotopic heart transplantation publication-title: Arq Bras Cardiol contributor: fullname: Vieira – volume: 11 start-page: 628 year: 1997 end-page: 632 ident: BIB6 article-title: Importance of decreased heart rate in predicting transplant coronary artery disease publication-title: Clin Transplant contributor: fullname: Hoang – volume: 19 start-page: 26 year: 1996 end-page: 30 ident: BIB3 article-title: Cardiac pacemakers in pediatric heart transplant recipients publication-title: Pacing Clin Electrophysiol contributor: fullname: Jutzy – volume: 20 start-page: 2398 year: 1997 end-page: 2404 ident: BIB2 article-title: Permanent atrial pacing in cardiac transplant patients publication-title: Pacing Clin Electrophysiol contributor: fullname: Curtis – volume: 10 start-page: 931 year: 1991 end-page: 936 ident: BIB7 article-title: Sudden death caused by bradycardia and asystole in a heart transplant patient with coronary arteriopathy publication-title: J Heart Lung Transplant contributor: fullname: Pratt – volume: 21 start-page: 2350 issue: 11 year: 1998 ident: 10.1016/S1053-2498(03)00058-5_BIB4 article-title: Declining need for pacemaker implantation after cardiac transplantation publication-title: Pacing Clin Electrophysiol doi: 10.1111/j.1540-8159.1998.tb01180.x contributor: fullname: Parry – volume: 10 start-page: 931 issue: 6 year: 1991 ident: 10.1016/S1053-2498(03)00058-5_BIB7 article-title: Sudden death caused by bradycardia and asystole in a heart transplant patient with coronary arteriopathy publication-title: J Heart Lung Transplant contributor: fullname: Grinstead – volume: 20 start-page: 2398 issue: 10 year: 1997 ident: 10.1016/S1053-2498(03)00058-5_BIB2 article-title: Permanent atrial pacing in cardiac transplant patients publication-title: Pacing Clin Electrophysiol doi: 10.1111/j.1540-8159.1997.tb06077.x contributor: fullname: Woodard – volume: 60 start-page: 1263 issue: 5 year: 1995 ident: 10.1016/S1053-2498(03)00058-5_BIB5 article-title: Permanent pacemaker for rejection episodes after heart transplantation publication-title: Ann Thorac Surg doi: 10.1016/0003-4975(95)00612-O contributor: fullname: Blanche – volume: 11 start-page: 628 issue: 6 year: 1997 ident: 10.1016/S1053-2498(03)00058-5_BIB6 article-title: Importance of decreased heart rate in predicting transplant coronary artery disease publication-title: Clin Transplant contributor: fullname: Gullestad – volume: 19 start-page: 26 issue: 1 year: 1996 ident: 10.1016/S1053-2498(03)00058-5_BIB3 article-title: Cardiac pacemakers in pediatric heart transplant recipients publication-title: Pacing Clin Electrophysiol doi: 10.1111/j.1540-8159.1996.tb04787.x contributor: fullname: Chinnock – volume: 74 start-page: 5 issue: 1 year: 2000 ident: 10.1016/S1053-2498(03)00058-5_BIB1 article-title: Permanent and temporary pacemaker implantation after orthotopic heart transplantation publication-title: Arq Bras Cardiol doi: 10.1590/S0066-782X2000000100002 contributor: fullname: Bacal |
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Snippet | Background: Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess... Few data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the... BACKGROUNDFew data are available regarding pacemaker implantation after pediatric orthotopic heart transplantation. The purpose of this study was to assess the... |
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SubjectTerms | Biological and medical sciences Bradycardia - diagnosis Bradycardia - prevention & control Cardiology. Vascular system Child Child, Preschool Coronary Artery Disease - diagnosis Coronary Artery Disease - prevention & control Coronary heart disease Heart Heart Transplantation - methods Humans Infant Medical sciences Pacemaker, Artificial Postoperative Complications - prevention & control Retrospective Studies Time Factors |
Title | Late pacemaker requirement after pediatric orthotopic heart transplantation may predict the presence of transplant coronary artery disease |
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