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Herrmann, Florian E. M.; Wellmann, Petra; Sadoni, Sebastian; Schramm, Rene; Hagl, Christian and Juchem, Gerd (2018): Sinus node dysfunction after heart transplantationAn analysis of risk factors and atrial pacing burden. In: Clinical Transplantation, Vol. 32, No. 3, e13202

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Abstract

IntroductionWe investigated the development of sinus node dysfunction (SND) requiring pacemaker implantation after heart transplant (HTx) especially regarding pacing burden in these patients. Patients and Methods: Patients requiring a pacemaker for SND were compared to all other patients in an HTx cohort including transplant patients from 1981 to 2016. Results: Sinus node dysfunction requiring pacemaker implantation developed in 118 patients (10%). These patients had received a biatrial anastomosis more frequently than those in the No SND group 95.8% vs 90.0% (P=.042). The ratio of reperfusion time to aortic cross-clamp time was significantly smaller in the SND group compared to the No SND group 71.7% vs 80.3% (P=.033). This also holds for the ratio of reperfusion time to ischemia time, which was 23.2% and 28.6%, respectively (P=.032). Pacing burden decreased from 90.5% to 66.3% after 2years and remained around this value in the remaining 4years of follow-up. Conclusion: We identified the biatrial anastomosis and a low ratio of reperfusion time to aortic cross-clamp time as well as to ischemia time as risk factors for SND requiring pacing. After implantation pacemakers continue to pace for over 60% of the time after 6years.

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