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Cardiac arrhythmias are often encountered in orthotopic hearttransplantation (OHT) recipients due to multiple risk factors and may lead to the necessity of permanent pacemaker implantation(PPI). Ischemic time > 4 hours has been associated with graft dysfunction.
Introduction Hearttransplantation (HT) is the only treatment option in children with heart failure secondary to cardiomyopathies and non-reparable congenital heart diseases. Three patients developed symptomatic sinus node dysfunction at 18, 25, and 38 days and received permanent pacemakers. months (IQR: 13.13–111.87),
1 Our interest was due in part to our prior work examining the stability of indices of pacemaker function and need for continued pacing among orthotopic hearttransplant (OHT) patients, which included a time period during which the bi-atrial anastomosis technique was still being performed at our institution.2
Wimmer et al regarding our article “Need for cardiac implantable electronic devices and long-term follow-up in recipients of orthotopic hearttransplants”. The question of pacemakers and impact on survival in orthotopic hearttransplant patients is thus far unanswered.1
Among pediatric patients undergoing orthotopic hearttransplantation (OHT), 1-12% are reported to need a permanent pacemaker (PPM).1 We studied a multi-institutional cohort of pediatric OHT recipients who received cardiac implantable electronic devices (CIED) after transplantation to explore the outcome.
Cardiac pacemaker implantation after orthotopic hearttransplantation declined dramatically after development of the bicaval anastomosis technique. However, much less is known about the rate, indications, and predictors of device implantations with current surgical technique.
In this issue of Heart Rhythm, Gowani, et al. ask us to reflect on a subset of 399 consecutive patients who underwent bicaval anastomotic orthotopic hearttransplantation at their institution from 1991-2017, of which 31 (8%) received cardiac electronic implantable devices (CIEDs). (1)
A 74-year-old man with a heterotopic hearttransplant experienced alternating episodes of sustained native heart ventricular tachycardia and prolonged asystole. These were managed with cardioversion, drug therapy and pacemaker insertion.
Green: Micra leadless pacemaker; blue: WiSE-CRT system LV endocardial electrode; and red: WiSE-CRT system subcutaneous battery and ultrasound generator. Carabelli A, Jabeur M, Jacon P, Rinaldi CA, European experience with a first totally leadless cardiac resynchronization therapy pacemaker system. 2021 May 21;23(5):740-747.
The primary composite endpoint included all-cause mortality, hearttransplantation, or ventricular assist device implantation. The secondary endpoint was first heart failure admission. 1.70), for both upgrade from pacemaker (multivariable HR 1.33, 95% CI 1.03–1.70) PSM for the secondary endpoint resulted in 277 pairs.
So in heart failure, one procedure that can help improve quality of life is the implantation of a biventricular pacemaker. It is worth knowing that people who may not have been deemed suitable for hearttransplantation once upon a time may now be candidates because the laws around organ donation have changed.
In hearttransplant patients with pacemakers, electrical parameters remained stable and within the device's operational safety margins, except for a decrease in P-wave amplitude that could be related to progressive graft fibrosis. A total of 861 adult HT were performed (92.1% years (IQR 2.515.1 years (IQR 2.08.1
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