Bacal F, Bocchi EA, Vieira ML, Lopes N, Moreira LF, Fiorelli A, Costa R, Martinelli M, Stolf NA, Bellotti G, Ramires JA
Instituto do Coracao do Hospital das Clinicas, FMUSP.
Arq Bras Cardiol. 2000 Jan;74(1):5-12.
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%) heart transplant recipients required temporary pacing and 4 of 114 (3.5%) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5%) and atrioventricular (AV) block in 3 patients (21.4%). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75%) and atrioventricular (AV) block in 1 patient (25%). We observed rejection in 3 patients (21.4%) who required temporary pacing and in 2 patients (50%) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4%) with temporary pacing. Seven of the 14 patients (50%) 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.
确定心脏移植受者临时和永久起搏器植入的适应证、发生率及演变情况。方法：回顾性分析1985年3月至1993年5月在InCor（圣保罗大学心脏研究所，巴西）接受原位心脏移植的114例患者。我们研究了临时起搏的发生率及适应证、起搏与排斥反应的关系、永久起搏的需求及临床随访情况。结果：114例心脏移植受者中，14例（12%）需要临时起搏，4例（3.5%）需要永久起搏。临时起搏的适应证为窦房结功能障碍11例（78.5%），房室传导阻滞3例（21.4%）。永久起搏器植入的适应证为窦房结功能障碍3例（75%），房室传导阻滞1例（25%）。我们观察到，在需要临时起搏的3例患者（21.4%）和需要永久起搏的2例患者（50%）中出现了排斥反应。在10例（71.4%）接受临时起搏的患者中观察到曾使用胺碘酮。14例患者中有7例（50%）在随访期间死亡。结论：窦房结功能障碍是心脏移植受者临时和永久起搏器植入的主要适应证。起搏需求与心脏移植后较差的预后相关。
