Uso de marcapasso provisório e definitivo em pacientes submetidos a transplante cardíaco ortotópico / Permanent and temporary pacemaker implantation after orthotopic heart transplantation

RESUMO

PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR) between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12 per cent) heart transplant recipients required temporary pacing and 4 of 114 (3.5 per cent) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5 per cent) and atrioventricular (AV) block in 3 patients (21.4 per cent). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75 per cent) and atrioventricular (AV) block in 1 patient (25 per cent). We observed rejection in 3 patients (21.4 per cent) who required temporary pacing and in 2 patients (50 per cent) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4 per cent) with temporary pacing. Seven of the 14 patients (50 per cent) died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.