Permanent Pacing for Late-Onset Atrioventricular Block in Patients with Heart Transplantation: A Single Center Experience

Introduction: The incidence, mechanisms, clinical associations, and outcomes in patients with late‐onset (>3 months) atrioventricular (AV) block following heart transplantation are not well known. This study will characterize late‐onset AV block following cardiac transplantation. Methods: We retrospectively reviewed our databases to identify patients who required pacemakers for late‐onset AV block postheart and heart‐lung transplantation from January 1990 to December 2007. Orthotopic heart and heart‐lung transplantation were separately analyzed. Results: This study included 588 adults who received cardiac transplants over a 17‐year period at our center (519 orthotopic, 64 heart‐lung transplants, and five heterotopic heart transplants). Of the 519 patients with orthotopic heart transplant, 39 required pacing (7.5%), 17 (3.3%) within 3 months posttransplant, 11 (2.1%) for late‐onset sinus node dysfunction (SND), 11 (2.1%) for late‐onset AV block. Also, five patients (7.8%) out of 64 heart‐lung transplants required pacemakers, two (3.1%) for late‐onset SND, three (4.7%) for late‐onset AV block. None of the five patients who underwent heterotopic transplant required cardiac pacing prior to or posttransplant. Conclusions: Late‐onset AV block occurs in 2.4% of patients with orthotopic heart transplant or heart‐lung transplant. AV block is predominantly intermittent and, often, does not progress to permanent AV block. There are no predictable factors for its onset. (PACE 2011; 72–75)