Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

Bradycardia during the early period following heart transplantation frequently occurs with an incidence of 14 to 44% and it is usually self-limited. The incidence of late bradycardia (from 30 days to more than 5 or 6 months after transplantation) has been reported to be 1.5%. A 33-year-old male patient with a history of orthotopic heart transplantation in 2013 presented with complaints of dizziness and near syncope. A DDDR permanent pacemaker was implanted for sinus pauses exceeding 3 seconds recorded on Holter examination. Shortly after the procedure, he developed sudden cardiovascular collapse. Cardiopulmonary resuscitation was performed and a pulse steroid treatment (2 grams of methylprednisolone) was given. After 2 days, the patient was extubated. While making preparations for re-transplantation, cardiopulmonary arrest developed again and he died. Sinus pause may be a clue for rejection and is an important finding in predicting clinical course.

Download Full-text

A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention

Healthcare ◽

10.3390/healthcare9030306 ◽

2021 ◽

Vol 9 (3) ◽

pp. 306

Author(s):

Alberto Emanuel Bacusca ◽

Andrei Tarus ◽

Alexandru Burlacu ◽

Mihail Enache ◽

Grigore Tinica

Keyword(s):

Heart Transplantation ◽

Meta Analysis ◽

Pacemaker Implantation ◽

Implantation Rate ◽

Permanent Pacemaker ◽

Orthotopic Heart Transplantation ◽

Redo Surgery ◽

Donor Heart ◽

Tricuspid Annuloplasty ◽

One Year

(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were as follows: the overall rate of postprocedural TR (immediate, one week, six months, and one year after the procedure), postoperative complications (permanent pacemaker implantation rate, bleeding), redo surgery for TR, and mortality. (3) Results: This meta-analysis included seven studies. Immediate postprocedural, one-week, six-month and one-year tricuspid insufficiency rates were significantly lower in the HTX-A group. There was no difference in permanent pacemaker implantation rate between the groups. The incidence of postoperative bleeding was similar in both arms. The rate of redo surgery for severe TR was reported only by two authors. In both publications, the total number of events was higher in the HTX cohort, meanwhile pooled effect analysis showed no difference among the intervention and control groups. Mortality at one year was similar in both arms. (4) Conclusion: Our study showed that donor heart TA reduces TR incidence in the first year after orthotopic heart transplantation without increasing the surgical complexity. This is a potentially important issue, given the demand for heart transplants and the need to optimize outcomes when this resource is scarce.

Download Full-text

AN INSTITUTIONAL REVIEW OF PERMANENT PACEMAKER IMPLANTATION AFTER ORTHOTOPIC HEART TRANSPLANTATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02189-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 830

Author(s):

Robby Wu ◽

Alexander Glaser ◽

Katherine Finley ◽

Jonathan DeWolf ◽

Nicholas Mencer ◽

...

Keyword(s):

Heart Transplantation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Orthotopic Heart Transplantation ◽

Permanent Pacemaker Implantation ◽

Institutional Review

Download Full-text

75: The Electrophysiologic Indication and the Long-Term Prognostic Implication of Permanent Pacemaker Implantation Early and Late after Heart Transplantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2007.11.080 ◽

2008 ◽

Vol 27 (2) ◽

pp. S86 ◽

Cited By ~ 1

Author(s):

D.H. Mortsell ◽

W. Hussain ◽

V. Markides ◽

E. Birks ◽

N.R. Banner ◽

...

Keyword(s):

Heart Transplantation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Prognostic Implication ◽

Permanent Pacemaker Implantation

Download Full-text

Abstract TP205: Clinical Aspects Of First-ever Stroke In Patients With Permanent Pacemaker

Stroke ◽

10.1161/str.44.suppl_1.atp205 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jiro Kitayama ◽

Hiroshi Nakane ◽

Hiromi Ishikawa ◽

Masahiro Shijo ◽

Masahiro Kamouchi ◽

...

Keyword(s):

Acute Stroke ◽

Pacemaker Implantation ◽

The United States ◽

Permanent Pacemaker ◽

Stroke Onset ◽

Clinical Aspects ◽

Stroke Patients ◽

Stroke Treatment ◽

Stroke Registry ◽

History Of

OBJECTIVES: Recently, increasing numbers of patients take pacemaker implantation: almost sixty thousands in Japan, and no less than two hundreds of thousands in the United States per year. Previous reports have indicated that prevalence of atrial fibrillation (Af) is high, and several coagulation markers are elevated in those with pacemaker. However, the precise features of stroke with implanted device are not clear. We, thus, examined the clinical aspects of stroke in pacemaker patients. METHODS: For the present study, we analyzed data from the Fukuoka Stroke Registry that is a multicenter epidemiological study database on acute stroke. From June 1999 to May 2011, 11376 ischemic stroke patients (72±12 years of age, female/male=4613/6763) who admitted to the hospital within seven days after onset were enrolled in the registry. Stroke subtypes were classified according to the diagnostic criteria of TOAST (Trial of Org 10172 in Acute Stroke Treatment). RESULTS: A total of 207 patients (1.8% of registered stroke patients) were with pacemaker. Among them, 130 patients had no history of any stroke. They appeared to be a mean age of 81±9 (range 42 to 97) years, and female/male ratio of 77/53. Mean duration from pacemaker implantation to stroke onset was 8±7 (median 6, quartile 3-11) years. 32 patients (25%) were given oral anticoagulant prior to stroke onset; 60 (46%) were on antiplatelet. Prevalence of Af in pacemaker patients was 48% (n=63). In those with Af, 48 patients (76%) were diagnosed as cardioembolic stroke, but only 22 (35%) were on anticoagulation before onset. Even in those without Af, 33 cases (49%) were also diagnosed as cardioembolic. The percentage of subjects with increased plasma D-dimer (≥1.5 μg/ml) was significantly higher in pacemaker group than no-pacemaker group, regardless of the presence or absence of Af (75% vs. 45% with Af; p<0.0001, 74% vs. 25% without Af; p<0.0001). CONCLUSIONS: In our current study, stroke in pacemaker patients revealed to have higher incidence of cardiogenic embolism, with or without Af. In addition, the majority was elderly, and failed to receive anticoagulant prior to stroke. It is needed to re-consider therapeutic strategy, including anticoagulation, for prevention of stroke in those with permanent pacemaker.

Download Full-text

An unyielding valve leading to venous spasm during pacemaker implantation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz142 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-4

Author(s):

Darshan Krishnappa ◽

Scott Sakaguchi ◽

Ganesh Kasinadhuni ◽

Venkatakrishna N Tholakanahalli

Keyword(s):

Pacemaker Implantation ◽

Distal Portion ◽

Permanent Pacemaker ◽

Permanent Pacemaker Implantation ◽

Case Summary ◽

Venous Puncture ◽

History Of ◽

Chemical Irritation ◽

Mechanical Irritation ◽

Uncommon Complication

Abstract Background Subclavian venous spasm is an uncommon complication during permanent pacemaker implantation. The exact aetiology of subclavian venous spasm is not clear but has been suggested to be due to either mechanical irritation of the vein during needle puncture or due to chemical irritation from contrast injection. Here, we report a case of an unyielding subclavian vein valve that impeded guidewire advancement and the repeated guidewire manipulation led to venous spasm. Case summary A 45-year-old woman with a history of surgical repair of Tetrology of Fallot in childhood presented with symptomatic bifascicular block and underwent a permanent pacemaker implantation. A subclavian venogram done prior to the procedure showed a prominent valve in the distal portion of the vein. Following venous puncture, guidewire advancement was impeded by the prominent valve. The resulting guidewire manipulation led to subclavian venous spasm necessitating a medial subclavian venous puncture and access. Discussion Prolonged mechanical irritation of the vein during pacemaker implantation may lead to venous spasm impeding pacemaker implantation. Early identification of an impeding valve and obtaining access medial to the valve may help prevent this uncommon complication.

Download Full-text

Permanent pacemaker implantation after pediatric heart transplantation: Risk factors, indications, and outcomes

Clinical Transplantation ◽

10.1111/ctr.13503 ◽

2019 ◽

Vol 33 (4) ◽

pp. e13503 ◽

Cited By ~ 2

Author(s):

Adil Mahmood ◽

Rachel Andrews ◽

Matthew Fenton ◽

Alanna Morrison ◽

Jasveer Mangat ◽

...

Keyword(s):

Risk Factors ◽

Heart Transplantation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Permanent Pacemaker Implantation ◽

Pediatric Heart Transplantation

Download Full-text

P1883Arrhythmias in transplanted hearts: Lessons from Europes largest cohort of patients who underwent orthotopic heart transplantation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0631 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Bergau ◽

M El-Hamriti ◽

S Molatta ◽

K Alzain ◽

V Rubesch-Kuetemeyer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Transplantation ◽

Large Cohort ◽

Background Information ◽

Orthotopic Heart Transplantation ◽

Atrial Ablation ◽

Successful Transplantation ◽

History Of ◽

Atrial Fibrillation And Flutter ◽

Supraventricular Tachycardias

Abstract Introduction Cardiac arrhythmias are regulary seen in patients following orthotopic heart transplantation (OHT). So far, there is no data available about the prevalence in a large cohort. Methods We retrospectively screened our database for subjects with OHT who received inpatient or outpatient treatment in our center between January 2000 and December 2018. All these patients were carefully reviewed with special attention to rhythm disturbances after successful transplantation. Results We identified a total number of 1890 subjects with history of OHT being treated in our center during the pre-defined time-period. The prevalence of supraventricular tachycardias was as follows: atrial fibrillation/atypical flutter and atrial ectopy 10%, AV-node-re-entry tachycardia 3%, typical atrial flutter 2% and higher degree AV-Block or Sick-Sinus-Syndrom (SSS) was 6%. Sustained ventricular tachycardia or ventricular premature contractions were present in 2%. Regarding the patients with arrhythmias, 13% received catheter ablation for arrhythmias, thereof 53% an atrial ablation (24% left atrial ablation), the remainder received a ventricular ablation. Conclusion In this very large cohort and following a long observational time, there was a higher incidence of atrial arrhythmias in patients following OHT as reported in healthy subjects with an emphasis on atrial fibrillation and flutter. This data gives a valuable background information on morbidity following OHT.

Download Full-text

The History of Experimental Heterotopic and Orthotopic Heart Transplantation Before Cardiopulmonary Bypass

Dawn and Evolution of Cardiac Procedures ◽

10.1007/978-88-470-2400-7_9 ◽

2012 ◽

pp. 79-83

Author(s):

Tyson A. Fricke ◽

Igor E. Konstantinov

Keyword(s):

Cardiopulmonary Bypass ◽

Heart Transplantation ◽

Orthotopic Heart Transplantation ◽

History Of

Download Full-text

Permanent Pacemaker Implantation in a Patient with Takotsubo Cardiomyopathy and Complete Atrioventricular Block

Case Reports in Cardiology ◽

10.1155/2021/6637720 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Toshihiro Terui ◽

Masumi Iwai-Takano ◽

Tomoyuki Watanabe

Keyword(s):

Takotsubo Cardiomyopathy ◽

Wall Motion ◽

Pacemaker Implantation ◽

Left Ventricular ◽

Permanent Pacemaker ◽

Av Block ◽

Permanent Pacemaker Implantation ◽

History Of ◽

Complete Atrioventricular ◽

Complete Av Block

This case report presents a patient with Takotsubo cardiomyopathy (TCM) and complete atrioventricular (AV) block who was treated with permanent pacemaker implantation. A 78-year-old woman with a history of hypertension presented with a 6-month history of palpitations. On initial evaluation, her heart rate was 40 beats/minute. Electrocardiography revealed a complete AV block and T-wave inversion in these leads: I, II, aVL, aVF, and V3–6. Echocardiography showed akinesis from the midventricle to the apex and hyperkinesis on the basal segments. The patient was diagnosed with TCM and complete AV block. Because improvement of TCM may subsequently improve the AV node dysfunction associated with TCM, the patient was admitted for treatment of heart failure without pacemaker implantation. The left ventricular (LV) abnormal wall motion improved gradually; however, the AV block persisted intermittently. On hospital day 14, a pause of 5–6 seconds without LV contraction was observed, and permanent pacemaker implantation was performed. On day 92, echocardiography revealed normal LV wall motion. However, electrocardiography revealed that the pacemaker rhythm with atrial sensing and ventricular pacing remained. Although specific degree of damage that may result from AV block associated with TCM is unknown, some of these patients require pacemaker implantation, despite improvement of abnormality in LV wall motion.

Download Full-text