Declining need for pacemaker implantation after cardiac transplantation.

The need for permanent pacemaker implantation was retrospectively reviewed in 436 consecutive cardiac transplant recipients at our center between 1985 and 1998. The incidence of pacemaker implantation was examined in three arbitrarily defined periods: period 1, 1985-1990, before a review of pacemaker implantation policy; period 2, 1991-1995, after a change in policy to delay pacemaker implantation resulting from the review; and period 3, 1996-1998, after audit of this policy change, and the introduction of a change in surgical technique, from the standard atrial anastomosis to the bicaval anastomosis. Pacemaker implantation was not required in any recipient after the change in surgical technique, suggesting that the bicaval technique preserves sinus node function much better than does the standard atrial anastomosis.