Arrhythmias, both ventricular and atrial, and sinus node dysfunction are extremely common occurrences after heart transplantation, although neither serves as an absolute indicator for pacemaker implantation. Drs Mallidi and Bates discuss the evolution of heart transplantation, the variety of postoperative indicators of disease, and the necessity for pacemaker implantation in their research article in the latest issue of the Ochsner Journal.
Their review of 1,450 heart transplants focused on the 5.8% of that population that received a pacemaker posttransplant. Distinguishing factors in the study included type of transplant (bicaval vs biatrial); time to pacemaker implantation (early vs late); and incidence of arrhythmia, sinus node dysfunction, and heart block. Bradycardia, in some cases related to an increased incidence of transplant coronary artery disease, also correlated to the necessity of late pacemaker implantation. Overall, the study showed a decreased rate of pacemaker use with a bicaval transplant, but the variety of factors involved in patient survival necessitates further study.