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Yan CL, Chaparro S, Thakkar Rivera N. Leadless pacemaker in heart transplantation: a case report and literature review. BMJ Case Rep 2023; 16:e256054. [PMID: 37696609 PMCID: PMC10496664 DOI: 10.1136/bcr-2023-256054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Our case demonstrates the safe and effective use of a leadless pacemaker in a heart transplant recipient. A man in his 60s with a history of heart transplantation with biatrial anastomosis 7 months prior presented to the emergency department after several syncopal episodes. Telemetry monitoring revealed a paroxysmal complete atrioventricular block. Given his immunocompromised state and prior dual chamber pacemaker extraction at the time of heart transplantation, the patient underwent successful implantation of a leadless pacemaker. Over the past 5 years since device implantation, the patient has not had any syncopal events nor has he had any device-related complications, such as infection.
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Affiliation(s)
| | - Sandra Chaparro
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Nina Thakkar Rivera
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, Florida, USA
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Alyaydin E, Pogoda C, Dell'Aquila A, Frommeyer G, Sindermann JR, Reinecke H, Tuleta I. Permanent pacing in a very long-term follow-up after orthotopic heart transplantation: A matter of when or why? Ann Noninvasive Electrocardiol 2022; 27:e12979. [PMID: 35670209 PMCID: PMC9296793 DOI: 10.1111/anec.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Orthotopic heart transplantation (OHT) is associated with a high incidence of conduction disturbances (CD) leading to permanent pacemaker (PPM) implantation. However, the improved posttransplant survival raises the question about the pacemaker dependence (PD) in a prolonged follow‐up. Hypothesis The prevalence of PPM in OHT is high but not all patients are PD in a very long‐term follow‐up. Device implantation has no prognostic relevance. Methods We performed a retrospective analysis of patient medical records focusing on device interrogation data at the most recent follow‐up. Results The study population consisted of 183 patients with a mean follow‐up of 15.0 ± 6.8 years. One‐fourth of the patients had undergone PPM implantation (n = 49, 26.8%). Among these, two‐thirds were PD at last follow‐up (n = 32, 65.3%). PPM was more often in biatrial OHT and cardiac allograft vasculopathy (OR 3.0, 95% CI 1.26–7.29, p = .013 and OR 2.0, 95% CI 1.03–3.87, p = .041, respectively). Early sinus node dysfunction (SND) was the most persistent CD. PPM was associated with a poorer outcome in OHT (HR 1.9, 95% CI 1.06–3.46, p = .031) and a higher rate of fatal septicemia (HR 5.1, 95% CI 1.41–18.14, p = .013). Conclusions One‐fourth of the OHT recipients develop CD requiring PPM implantation, although one‐third among these are not PD in follow‐up. Early SND is associated with a higher rate of PD. PPM is associated with an inferior prognosis.
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Affiliation(s)
- Emyal Alyaydin
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Christian Pogoda
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Angelo Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Juergen R Sindermann
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.,Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Izabela Tuleta
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 137] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 851] [Impact Index Per Article: 283.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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DeFilippis EM, Rubin G, Farr MA, Biviano A, Wan EY, Takeda K, Garan H, Topkara VK, Yarmohammadi H. Cardiac Implantable Electronic Devices Following Heart Transplantation. JACC Clin Electrophysiol 2020; 6:1028-1042. [PMID: 32819520 DOI: 10.1016/j.jacep.2020.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022]
Abstract
Permanent pacemaker (PPM) implantation is required in a subset of patients (∼10%) for sinus node dysfunction or atrioventricular block both early and late after heart transplantation. The incidence of PPM implantation has decreased to <5% with the advent of bicaval anastamosis transplantation surgery. Pacing dependence upon follow-up has been variably reported. An even smaller percentage of transplantation recipients (1.5% to 3.4%) undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous data are lacking for the use of ICDs in the transplantation population and is largely derived from cohort studies and case series. Sudden cardiac death occurs in approximately 10% of transplantation recipients, but multiple nonarrhythmic factors are believed to be responsible, including acute rejection, late graft failure with electromechanical dissociation, and ischemia due to cardiac allograft vasculopathy. This review provides a comprehensive analysis of the existing data regarding the role for PPMs and ICDs in this population, including leadless PPMs and subcutaneous ICDs, special considerations, and future directions.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
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Uchikawa T, Fujino T, Higo T, Ohtani K, Shiose A, Tsutsui H. Cilostazol Is Useful for the Treatment of Sinus Bradycardia and Associated Hemodynamic Deterioration Following Heart Transplantation. Int Heart J 2019; 60:1222-1225. [DOI: 10.1536/ihj.19-116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tomoki Uchikawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Akira Shiose
- Department of Cardiovascular Surgery, Faculty of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Zweerink A, van der Lingen ALCJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic Incompetence in Chronic Heart Failure. Circ Heart Fail 2019; 11:e004969. [PMID: 30354566 DOI: 10.1161/circheartfailure.118.004969] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. In patients with heart failure (HF), however, this definition is unsuitable because metabolic demands are unmatched to cardiac output in both conditions. Moreover, HR dynamics in patients with HF differ from those in healthy subjects and may be affected by β-blocking medication. Nevertheless, it has been demonstrated that CI in HF is associated with reduced functional capacity and poor survival. During exercise, the normal heart increases both stroke volume and HR, whereas in the failing heart, contractility reserve is lost, thus rendering increases in cardiac output primarily dependent on cardioacceleration. Consequently, insufficient cardioacceleration because of CI may be considered a major limiting factor in the exercise capacity of patients with HF. Despite the profound effects of CI in this specific population, the issue has drawn limited attention during the past years and is often overlooked in clinical practice. This might partly be caused by a lack of standardized approach to diagnose the disease, further complicated by changes in HR dynamics in the HF population, which render reference values derived from a normal population invalid. Cardiac implantable electronic devices (implantable cardioverter defibrillator; cardiac resynchronization therapy) now offer a unique opportunity to study HR dynamics and provide treatment options for CI by rate-adaptive pacing using an incorporated sensor that measures physical activity. This review provides an overview of disease mechanisms, diagnostic strategies, clinical consequences, and state-of-the-art device therapy for CI in HF.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | | | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moaveni DM, Cohn JH, Hoctor KG, Longman RE, Ranasinghe JS. Anesthetic Considerations for the Parturient After Solid Organ Transplantation. Anesth Analg 2017; 123:402-10. [PMID: 27285002 DOI: 10.1213/ane.0000000000001391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents. These women are at an increased risk of comorbidities and obstetric complications. Anesthetic management should consider the important task of protecting graft function. Optimal care of a woman with a transplanted solid organ involves management by a multidisciplinary team. In this focused review article, we review the anesthetic management of pregnant patients with solid organ transplants of the kidney, liver, heart, or lung.
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Affiliation(s)
- Daria M Moaveni
- From the Departments of *Clinical Anesthesiology and †Obstetrics and Gynecology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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WELLMANN PETRA, HERRMANN FLORIANERNSTMARTIN, HAGL CHRISTIAN, JUCHEM GERD. A Single Center Study of 1,179 Heart Transplant Patients-Factors Affecting Pacemaker Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:247-254. [DOI: 10.1111/pace.13021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/16/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Affiliation(s)
- PETRA WELLMANN
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | | | - CHRISTIAN HAGL
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - GERD JUCHEM
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
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Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med 2016; 34:2200-2208. [DOI: 10.1016/j.ajem.2016.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023] Open
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Manankil M, Aggarwal A, Pauwaa S, Bhat G. Correlation of noninvasive markers of cardiac allograft rejection with endomyocardial biopsy: a case report. Heart Lung 2012; 41:518-21. [PMID: 22421504 DOI: 10.1016/j.hrtlng.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
Although endomyocardial biopsy remains the gold standard to diagnose cardiac allograft rejection, the search continues for clinical parameters that may aid in the early diagnosis of rejection. We report the case of a 29-year-old man who underwent orthotopic heart transplantation and subsequently had multifocal moderate allograft rejection. During the patient's hospital course, he exhibited a number of clinical parameters that served as important clues for the worsening rejection. After aggressive immunosuppression, the improvement of these markers hinted toward his eventual recovery.
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Affiliation(s)
- Marian Manankil
- Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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Jones DG, Mortsell DH, Rajaruthnam D, Hamour I, Hussain W, Markides V, Banner NR, Wong T. Permanent pacemaker implantation early and late after heart transplantation: Clinical indication, risk factors and prognostic implications. J Heart Lung Transplant 2011; 30:1257-65. [DOI: 10.1016/j.healun.2011.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 05/21/2011] [Accepted: 05/28/2011] [Indexed: 10/18/2022] Open
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Noworolski R, Przybylowski P, Majewski J, Sadowski J, Lelakowski J. Early and Late Indications for Implantation of Cardiac Pacemakers in Patients After Heart Transplantation: A Single-Center Experience. Transplant Proc 2011; 43:3074-5. [DOI: 10.1016/j.transproceed.2011.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beyenbach KW, Piermarini PM. Transcellular and paracellular pathways of transepithelial fluid secretion in Malpighian (renal) tubules of the yellow fever mosquito Aedes aegypti. Acta Physiol (Oxf) 2011; 202:387-407. [PMID: 20946239 PMCID: PMC3032036 DOI: 10.1111/j.1748-1716.2010.02195.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Isolated Malpighian tubules of the yellow fever mosquito secrete NaCl and KCl from the peritubular bath to the tubule lumen via active transport of Na(+) and K(+) by principal cells. Lumen-positive transepithelial voltages are the result. The counter-ion Cl(-) follows passively by electrodiffusion through the paracellular pathway. Water follows by osmosis, but specific routes for water across the epithelium are unknown. Remarkably, the transepithelial secretion of NaCl, KCl and water is driven by a H(+) V-ATPase located in the apical brush border membrane of principal cells and not the canonical Na(+), K(+) -ATPase. A hypothetical cation/H(+) exchanger moves Na(+) and K(+) from the cytoplasm to the tubule lumen. Also remarkable is the dynamic regulation of the paracellular permeability with switch-like speed which mediates in part the post-blood-meal diuresis in mosquitoes. For example, the blood meal the female mosquito takes to nourish her eggs triggers the release of kinin diuretic peptides that (i) increases the Cl(-) conductance of the paracellular pathway and (ii) assembles V(1) and V(0) complexes to activate the H(+) V-ATPase and cation/H(+) exchange close by. Thus, transcellular and paracellular pathways are both stimulated to quickly rid the mosquito of the unwanted salts and water of the blood meal. Stellate cells of the tubule appear to serve a metabolic support role, exporting the HCO(3)(-) generated during stimulated transport activity. Septate junctions define the properties of the paracellular pathway in Malpighian tubules, but the proteins responsible for the permselectivity and barrier functions of the septate junction are unknown.
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Affiliation(s)
- K W Beyenbach
- Department of Biomedical Sciences, VRT 8004, Cornell University, Ithaca, NY, USA.
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Lee KJ, Jung YS, Lee CJ, Wi J, Shin S, Kim T, Lee SH, Kang SM, Lee MH, Park HK. Permanent pacemaker for syncope after heart transplantation with bicaval technique. Yonsei Med J 2009; 50:588-90. [PMID: 19718412 PMCID: PMC2730626 DOI: 10.3349/ymj.2009.50.4.588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/14/2007] [Accepted: 12/14/2007] [Indexed: 11/27/2022] Open
Abstract
Sinus node dysfunction occurs occasionally after heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy, and increasing donor age. However, the timing and indication of permanent pacemaker insertion due to sinus node dysfunction following heart transplantation is contentious. Here, we report a case of a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with a bicaval technique, which has been known to associate with few incidences of sinus node dysfunction.
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Affiliation(s)
- Kyong Joo Lee
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Sook Jung
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Joo Lee
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Wi
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghoon Shin
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Taehoon Kim
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hak Lee
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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Cantillon DJ, Gorodeski EZ, Caccamo M, Smedira NG, Wilkoff BL, Starling RC, Saliba W. Long-term Outcomes and Clinical Predictors for Pacing After Cardiac Transplantation. J Heart Lung Transplant 2009; 28:791-8. [DOI: 10.1016/j.healun.2009.04.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 11/05/2008] [Accepted: 04/29/2009] [Indexed: 10/20/2022] Open
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23
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Lim S, Marshall H. Broad complex tachycardia and atrioventricular dissociation in a patient with heart transplant. Europace 2009; 11:265-7. [PMID: 19131344 DOI: 10.1093/europace/eun358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sern Lim
- University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
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LUEBBERT JEFFREYJ, LEE FORRESTERA, ROSENFELD LYNDAE. Pacemaker Therapy for Early and Late Sinus Node Dysfunction in Orthotopic Heart Transplant Recipients: A Single-Center Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1108-12. [DOI: 10.1111/j.1540-8159.2008.01149.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Incidence, Predictors, and Outcomes of Cardiac Pacing After Cardiac Transplantation: An 11-Year Retrospective Analysis. Transplantation 2008; 85:1216-8. [DOI: 10.1097/tp.0b013e31816b677c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Collins KK, Thiagarajan RR, Chin C, Dubin AM, Van Hare GF, Robbins RC, Mayer JE, Bernstein D, Berul CI, Blume ED. Atrial tachyarrhythmias and permanent pacing after pediatric heart transplantation. J Heart Lung Transplant 2004; 22:1126-33. [PMID: 14550822 DOI: 10.1016/s1053-2498(02)01193-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial tachyarrhythmias have been reported in as high as 50% of adult heart recipients. Limited information is available on arrhythmias in pediatric transplant patients. Our objective was to determine the prevalence and significance of atrial tachyarrhythmias and permanent pacing following pediatric heart transplantation. METHODS A retrospective review of the medical records, electrocardiograms, and Holter recordings of all consecutive patients following heart transplantation at Children's Hospital, Boston (n = 104) and Lucile Packard Children's Hospital, Stanford (n = 123) was performed. The study group consisted of 227 patients with a median age at transplant of 10.2 yrs (1 day-23.3 yrs). RESULTS Atrial tachyarrhythmias occurred in 32 patients (14%) at a median of 15 days post-transplant (1 day-9.2 yrs) and included atrial flutter (n = 13), atrial fibrillation (n = 7), ectopic atrial tachycardia (n = 5), atrioventricular reciprocating tachycardia or atrioventricular node reentry (n = 5), and other (n = 2). Atrial flutter was the only tachyarrhythmia associated with allograft rejection (6/13 atrial flutter vs. 0/7 atrial fibrillation vs. 0/5 ectopic atrial tachycardia, p = 0.03). Patients with atrial fibrillation had a 2.5 fold (95%CI 1.7-3.5) higher risk of death or retransplant compared to patients without atrial fibrillation. Ectopic atrial tachycardia tended to occur in younger recipients compared to atrial fibrillation and flutter (2.7 yrs vs 18.6 yrs and 8.5 yrs respectively, p = 0.06) and was associated with a benign clinical course. There was no association between atrial tachyarrhythmias and graft ischemic time, surgical technique, or coronary artery disease. Pacemakers were required in 12 patients (5.2%), 7 with sinus node dysfunction and 5 for intermittent complete atrioventricular block. There was no consistent association between the need for permanent pacing and coronary artery disease, rejection, or surgical technique. CONCLUSIONS Atrial tachyarrhythmias and permanent pacing were uncommon in this cohort of pediatric heart transplant recipients. Association with cardiac rejection, clinical course, and mortality varied depending on the tachyarrhythmia mechanism.
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Affiliation(s)
- Kathryn K Collins
- Pediatric Arrhythmia Center, University of California-San Francisco, San Francisco, CA, USA
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Hasdemir C, Chandrasekaran K, Lazzara R, Reynolds DW. Sinus node dysfunction in a heart transplant patient secondary to severe sinus node artery obstruction--a case report. Angiology 2004; 54:725-8. [PMID: 14666963 DOI: 10.1177/000331970305400614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of sinus node dysfunction is reported secondary to severe sinus node artery obstruction 3 years after orthotopic heart transplantation. The patient first presented with frequent dizzy spells and presyncopal episodes for 3 months and then recurrent syncope in the presence of an acute myocardial infarction. Coronary angiography showed a diffusely narrowed sinus node artery without any apparent collateral vessels. The sinus node artery had had only minimal distal disease 3 months previously. A dual chamber permanent pacemaker was implanted with significant improvement in clinical symptoms.
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Affiliation(s)
- Can Hasdemir
- Cardiovascular Section and Cardiac Arrhythmia Research Institute, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA
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28
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Goldstein DR, Coffey CS, Benza RL, Nanda NC, Bourge RC. Relative perioperative bradycardia does not lead to adverse outcomes after cardiac transplantation. Am J Transplant 2003; 3:484-91. [PMID: 12694073 DOI: 10.1034/j.1600-6143.2003.00073.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the effects of bradycardia after cardiac transplantation are not known, we tested the hypothesis that perioperative bradycardia would lead to an increase in adverse outcomes after cardiac transplantation. We conducted a retrospective case control study with inclusion criterion of a heart rate (HR) less than 80 bpm during the 1st week after transplantation. Control patients were matched for gender, age and time since transplantation. We identified 34 patients as having perioperative bradycardia out of the 174 who underwent cardiac transplantation between 1994 and 1997. The results demonstrated no significant differences in donor ischemic times (180 vs. 183, p = 0.88), operative surgeon (p = 0.62) or pretransplant cardiac disease (p = 0.81) between groups. Bradycardic patients were more likely to be on pretransplant amiodarone (RR = 20.4, p < 0.001). Perioperative bradycardia did not lead to increases in cellular rejection (p = 0.72) or vasculopathy (p = 0.79). The patients prescribed pretransplant amiodarone (n = 14) had a trend toward delayed time to first rejection episode (31.0 vs. 15.5 days, median, p = 0.07). In conclusion, perioperative bradycardia does not increase adverse outcomes after cardiac transplantation and is associated with pretransplant use of amiodarone. Amiodarone may modify the recipients' immune response by delaying the occurrence of rejection.
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Affiliation(s)
- Daniel R Goldstein
- Department of Internal Medicine, Division of Cardiovascular Medicine, Yale University School of Medicine, 3FM-Cardiology, 333 Cedar St, New Haven CT 06520, USA.
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Lai CL, Chen WJ, Wang SS, Liu YB, Lin FY, Lee YT, Chu SH. Bradyarrhythmias and cardiac pacing after orthotopic heart transplantation in a Chinese population. Transplant Proc 2002; 34:3232-5. [PMID: 12493430 DOI: 10.1016/s0041-1345(02)03556-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C-L Lai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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31
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Pinski SL. Optimal cardiac pacing after heart transplantation. Pacing Clin Electrophysiol 2000; 23:926-7. [PMID: 10833720 DOI: 10.1111/j.1540-8159.2000.tb00871.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Herre JM, Barnhart GR, Llano A. Cardiac pacemakers in the transplanted heart: short term with the biatrial anastomosis and unnecessary with the bicaval anastomosis. Curr Opin Cardiol 2000; 15:115-20. [PMID: 10963149 DOI: 10.1097/00001573-200003000-00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sinus node dysfunction occurs commonly after orthotopic heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy and increasing donor age. In the past, using the standard biatrial technique described originally by Lower and Shumway, many series have reported permanent pacing in more than 10% of patients. Unlike sinus node dysfunction in nontransplanted patients, which typically worsens with time, sinus node dysfunction in the transplanted heart usually improves over a period of weeks to months. Delaying the implantation of a permanent pacemaker may render it unnecessary. The development of the bicaval technique for implantation of the donor heart appears to have decreased even further or even eliminated the need for early permanent pacing. Because sinus node dysfunction in the transplanted heart does not predict subsequent development of atrioventricular (AV) node dysfunction, rate-responsive atrial pacing should be used in the majority of cases. Even after appropriate pacing for sinus node dysfunction, the sinus node may recover and permanent pacing may be discontinued. AV conduction abnormalities are far less common and generally occur late after transplantation. Dual-chamber pacing is required and permanent pacing should be continued indefinitely.
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Affiliation(s)
- J M Herre
- Department of Medicine, Eastern Virginia Medical School and Sentara Norfolk General Hospital, USA
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