Sant'Anna J R, Costa A R, Kalil R A, Lucchese F A, Prates P R, Pereira E, Nesralla I A
Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS.
Arq Bras Cardiol. 1992 Nov;59(5):373-7.
The indications and the results of pacemaker implant following orthotopic cardiac transplantation.
Four patients implanted a cardiac pacemaker (PM) in the early post-operative period (PO) of orthotopic cardiac transplantation (from 10th to 16th PO day). The patients were 33 to 55 year-old and the indications to PM were supraventricular arrhythmia (atrial fibrillation or flutter) associated with atrioventricular block in three, and complete atrioventricular block in one patient. Previous to PM implant, patients were submitted to endomyocardial biopsy, which was normal in two patients, evidenced mild rejection in one and moderate rejection in the remaining. A ventricular rate responsive pacemaker was implanted in all patients, with sensors responsive to muscular activity in one patient, and to minute ventilation in three.
One patient died in the 20th PO due to acute allograft rejection not controlled by immunosuppressive drugs. Three other patients had satisfactory evolution and the pacemakers were programmed during exercise testing, previous to hospital discharge. Recent evaluation revealed that these patients are in good clinical condition at the 6th, 14th and 24th PO months. Adequate pacemaker function was insured by exercise testing and ambulatory electrocardiographic recording.
A ventricular rate responsive pacemaker represented a satisfactory mode of pacing, in patients with severe bradycardia, following heart transplantation.
原位心脏移植后起搏器植入的适应症及结果。
4例患者在原位心脏移植术后早期（术后第10至16天）植入心脏起搏器（PM）。患者年龄在33至55岁之间，植入PM的适应症为3例伴有房室传导阻滞的室上性心律失常（心房颤动或扑动），1例完全性房室传导阻滞。在植入PM之前，患者接受了心内膜活检，其中2例结果正常，1例显示轻度排斥反应，其余1例为中度排斥反应。所有患者均植入了心室率应答式起搏器，其中1例患者的传感器对肌肉活动有反应，3例对分钟通气量有反应。
1例患者在术后第20天因免疫抑制药物无法控制的急性移植物排斥反应死亡。其他3例患者病情进展良好，在出院前进行运动测试时对起搏器进行了程控。近期评估显示，这些患者在术后第6、14和24个月时临床状况良好。通过运动测试和动态心电图记录确保了起搏器功能正常。
对于心脏移植后出现严重心动过缓的患者，心室率应答式起搏器是一种令人满意的起搏方式。
