Pacemaker upgrade causing new-onset heart failure in a patient with complete congenital atrioventricular block.

For infants with congenital complete atrioventricular block (CCAVB), the choice of pacing modalities is limited. Due to their size and surgical limitations, neonates typically start with an epicardial right ventricular pacing system, then upgrade to right-sided dual-chamber pacing once appropriate size is achieved. These modes are generally well tolerated. However, the reported case involved a patient with CCAVB who paradoxically experienced congestive heart failure after upgrading to a dual-chamber system, a theoretically superior pacing modality. With conversion to biventricular pacing, a relatively new modality for adults with very little pediatric experience to date, the patient's symptoms dramatically improved.

Cardiac transplantation in Hawai'i: a summary of the first 21 years.

Between 1987 and 2008, 45 patients have undergone cardiac transplantation in Hawai'i. This article summarizes the authors' experiences with cardiac transplantation over this 21-year period. The cumulative 1-, 3- and 5-year survival rates after transplantation have been 73.8%, 70.0%, and 63.2%, respectively. The corresponding survival rates have improved over the last eight years and are now 90.0%, 87.5%, and 83.3%, respectively. Despite clinical improvements, low patient volumes make the maintenance of a state-based program in Hawai'i difficult. Problems with financing and referral biases will need to be addressed if a local program is to continue.