Sinus node function in first three weeks after cardiac transplantation.

Abstract

SUMMARY Donor sinus node function was studied in 10 patients from day 4 to day 24 after cardiac transplantation. Cycle length, atrial arrhythmias, corrected sinus node recovery time, and estimated sinoatrial conduction time were recorded daily. Five patients had at least two sets of results suggesting sinus node dysfunction (group A) while five patients had no such abnormalities (group B). The prognosis in group A was poor, with four of the five patients dying within four months ofthe operation; one unexpected death from arrhythmi'as'was recorded by'ambulatory electrocardiographic monitoring. All five patients in group B survived for at least eight months. In nine patients sinus node function varied from day to day, with corrected sinus node recovery time reaching a peak at 11 to 18 days after operation. The longest corrected sinus node recovery time was 11 160 ms. Neither the differences between the patients, nor the day to day variation, could be explained solely by the degree of rejection as assessed by biopsy or by the ischaemia time ofthe heart during procurement. Sinus node dysfunction soon after transplantation is associated with a poorer prognosis and might be the terminal event in some cases.

Relative Perioperative Bradycardia Does Not Lead to Adverse Outcomes After Cardiac Transplantation

“…However, since intravascular ultrasound, a more sensitive indicator of vasculopathy than angiography, was not used to document evidence of chronic rejection, we cannot exclude the possibility that early bradycardia may have an impact in the development of allograft vasculopathy. Our results extend the findings of other studies that have shown that perioperative bradycardia is not associated with rejection within the first months after transplantation (1,7,19). The data also agree with the study by Heinz et al which demonstrated that bradycardia was not associated with a decreased survival several years after transplantation (9).…”

Permanent and temporary pacemaker implantation after orthotopic heart transplantation

“…Local trauma to the superior vena cava, donor age, inadequate denervated heart response to vasoactive amines and previous use of antiarrhythmic drugs, especially amiodarone, may be involved 4,5,8,9,11,12,13,17,23 .…”

“…Studies in retransplantation or necropsy have shown that cardiac conduction tissue is a specific target related to allograft rejection 13 . The arteries to sinoatrial and atrioventricular tissue are frequently involved in both an acute cellular reaction and in the chronic intimal fibro-cellular rejection reaction, causing sinus node dysfunction 24 .…”

“…The transplant recipient thus has two sinus nodes with electrical activity and eletrocardiography expression totally independent of the surface eletrocardiogram. The donor sinus node is responsible for electrical stimulation despite its anatomical and functional denervation 3,13,16 . Normal sinus node function is dependent on a complex balance between intrinsic sinus node electrophysiologic properties, sinoatrial conduction properties and a number of extrinsic factors, the most important of which is the autonomic nervous system 17 .…”

“…These arrhythmias are sometimes transient and asymptomatic and recovery of cardiac rhythm occurs overtime, although many authors suggest that sinus node dysfunction soon after transplantation is related to a poorer prognosis 13 .…”