Eliminating bradyarrhythmias after orthotopic heart transplantation

Steven A. Rothman, Valluvan Jeevanandam, William G. Combs, Satoshi Furukawa, Henry H. Hsia, Howard J. Eisen, Alfred E. Buxton, John M. Miller

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Bradycardia and sinus node dysfunction are common causes of early postoperative morbidity in orthotopic heart transplant recipients and frequently require the use of chronotropic drugs or permanent pacemakers. Several causes have been postulated, including surgical trauma to the sinus node and its blood supply. We sought to eliminate sinus node dysfunction and postoperative bradyarrhythmias by altering the orthotopic heart transplantation technique. Methods and Results: Seventy orthotopic heart transplant recipients underwent electrophysiological testing of sinus node function a mean of 9±3 days after surgery. Standard (atrial anastomosis) orthotopic heart transplantation was performed in 33 patients; total (bicaval anastomosis) heart transplantation was performed in 37 patients. Abnormalities of sinus node function were present in 14 of 33 patients (42%) undergoing standard orthotopic heart transplantation compared with 2 of 37 patients arrhythmia(5%) in whom total heart transplantation was performed (p<.005). The resting sinus heart rate of patients with a normal sinus rhythm was also significantly higher in the total heart transplantation group (90±12 versus 83±14 bpm, P<.05). Coronary angiography was performed before discharge in 63 patients. Eleven were found to have an abnormal sinoatrial nodal artery, and 7 of these patients also had evidence of sinus node dysfunction (P<.005). Conclusions: Surgical trauma to the donor sinus node and/or its blood supply is a significant cause of sinus node dysfunction in the orthotopic heart transplant recipient. By use of a bicaval anastomotic technique, the incidence of and need for treatment of postoperative bradyarrhythmias can be significantly reduced.

Original languageEnglish (US)
Pages (from-to)II278-II282
JournalCirculation
Volume94
Issue number9 SUPPL.
StatePublished - Nov 1 1996

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Heart Transplantation
Bradycardia
Sick Sinus Syndrome
Sinoatrial Node
Wounds and Injuries
Coronary Angiography
Ambulatory Surgical Procedures
Cardiac Arrhythmias
Arteries
Heart Rate
Tissue Donors
Morbidity
Incidence
Pharmaceutical Preparations
Transplant Recipients

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Rothman, S. A., Jeevanandam, V., Combs, W. G., Furukawa, S., Hsia, H. H., Eisen, H. J., ... Miller, J. M. (1996). Eliminating bradyarrhythmias after orthotopic heart transplantation. Circulation, 94(9 SUPPL.), II278-II282.
Rothman, Steven A. ; Jeevanandam, Valluvan ; Combs, William G. ; Furukawa, Satoshi ; Hsia, Henry H. ; Eisen, Howard J. ; Buxton, Alfred E. ; Miller, John M. / Eliminating bradyarrhythmias after orthotopic heart transplantation. In: Circulation. 1996 ; Vol. 94, No. 9 SUPPL. pp. II278-II282.
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abstract = "Background: Bradycardia and sinus node dysfunction are common causes of early postoperative morbidity in orthotopic heart transplant recipients and frequently require the use of chronotropic drugs or permanent pacemakers. Several causes have been postulated, including surgical trauma to the sinus node and its blood supply. We sought to eliminate sinus node dysfunction and postoperative bradyarrhythmias by altering the orthotopic heart transplantation technique. Methods and Results: Seventy orthotopic heart transplant recipients underwent electrophysiological testing of sinus node function a mean of 9±3 days after surgery. Standard (atrial anastomosis) orthotopic heart transplantation was performed in 33 patients; total (bicaval anastomosis) heart transplantation was performed in 37 patients. Abnormalities of sinus node function were present in 14 of 33 patients (42{\%}) undergoing standard orthotopic heart transplantation compared with 2 of 37 patients arrhythmia(5{\%}) in whom total heart transplantation was performed (p<.005). The resting sinus heart rate of patients with a normal sinus rhythm was also significantly higher in the total heart transplantation group (90±12 versus 83±14 bpm, P<.05). Coronary angiography was performed before discharge in 63 patients. Eleven were found to have an abnormal sinoatrial nodal artery, and 7 of these patients also had evidence of sinus node dysfunction (P<.005). Conclusions: Surgical trauma to the donor sinus node and/or its blood supply is a significant cause of sinus node dysfunction in the orthotopic heart transplant recipient. By use of a bicaval anastomotic technique, the incidence of and need for treatment of postoperative bradyarrhythmias can be significantly reduced.",
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Rothman, SA, Jeevanandam, V, Combs, WG, Furukawa, S, Hsia, HH, Eisen, HJ, Buxton, AE & Miller, JM 1996, 'Eliminating bradyarrhythmias after orthotopic heart transplantation', Circulation, vol. 94, no. 9 SUPPL., pp. II278-II282.

Eliminating bradyarrhythmias after orthotopic heart transplantation. / Rothman, Steven A.; Jeevanandam, Valluvan; Combs, William G.; Furukawa, Satoshi; Hsia, Henry H.; Eisen, Howard J.; Buxton, Alfred E.; Miller, John M.

In: Circulation, Vol. 94, No. 9 SUPPL., 01.11.1996, p. II278-II282.

Research output: Contribution to journalArticle

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T1 - Eliminating bradyarrhythmias after orthotopic heart transplantation

AU - Rothman, Steven A.

AU - Jeevanandam, Valluvan

AU - Combs, William G.

AU - Furukawa, Satoshi

AU - Hsia, Henry H.

AU - Eisen, Howard J.

AU - Buxton, Alfred E.

AU - Miller, John M.

PY - 1996/11/1

Y1 - 1996/11/1

N2 - Background: Bradycardia and sinus node dysfunction are common causes of early postoperative morbidity in orthotopic heart transplant recipients and frequently require the use of chronotropic drugs or permanent pacemakers. Several causes have been postulated, including surgical trauma to the sinus node and its blood supply. We sought to eliminate sinus node dysfunction and postoperative bradyarrhythmias by altering the orthotopic heart transplantation technique. Methods and Results: Seventy orthotopic heart transplant recipients underwent electrophysiological testing of sinus node function a mean of 9±3 days after surgery. Standard (atrial anastomosis) orthotopic heart transplantation was performed in 33 patients; total (bicaval anastomosis) heart transplantation was performed in 37 patients. Abnormalities of sinus node function were present in 14 of 33 patients (42%) undergoing standard orthotopic heart transplantation compared with 2 of 37 patients arrhythmia(5%) in whom total heart transplantation was performed (p<.005). The resting sinus heart rate of patients with a normal sinus rhythm was also significantly higher in the total heart transplantation group (90±12 versus 83±14 bpm, P<.05). Coronary angiography was performed before discharge in 63 patients. Eleven were found to have an abnormal sinoatrial nodal artery, and 7 of these patients also had evidence of sinus node dysfunction (P<.005). Conclusions: Surgical trauma to the donor sinus node and/or its blood supply is a significant cause of sinus node dysfunction in the orthotopic heart transplant recipient. By use of a bicaval anastomotic technique, the incidence of and need for treatment of postoperative bradyarrhythmias can be significantly reduced.

AB - Background: Bradycardia and sinus node dysfunction are common causes of early postoperative morbidity in orthotopic heart transplant recipients and frequently require the use of chronotropic drugs or permanent pacemakers. Several causes have been postulated, including surgical trauma to the sinus node and its blood supply. We sought to eliminate sinus node dysfunction and postoperative bradyarrhythmias by altering the orthotopic heart transplantation technique. Methods and Results: Seventy orthotopic heart transplant recipients underwent electrophysiological testing of sinus node function a mean of 9±3 days after surgery. Standard (atrial anastomosis) orthotopic heart transplantation was performed in 33 patients; total (bicaval anastomosis) heart transplantation was performed in 37 patients. Abnormalities of sinus node function were present in 14 of 33 patients (42%) undergoing standard orthotopic heart transplantation compared with 2 of 37 patients arrhythmia(5%) in whom total heart transplantation was performed (p<.005). The resting sinus heart rate of patients with a normal sinus rhythm was also significantly higher in the total heart transplantation group (90±12 versus 83±14 bpm, P<.05). Coronary angiography was performed before discharge in 63 patients. Eleven were found to have an abnormal sinoatrial nodal artery, and 7 of these patients also had evidence of sinus node dysfunction (P<.005). Conclusions: Surgical trauma to the donor sinus node and/or its blood supply is a significant cause of sinus node dysfunction in the orthotopic heart transplant recipient. By use of a bicaval anastomotic technique, the incidence of and need for treatment of postoperative bradyarrhythmias can be significantly reduced.

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Rothman SA, Jeevanandam V, Combs WG, Furukawa S, Hsia HH, Eisen HJ et al. Eliminating bradyarrhythmias after orthotopic heart transplantation. Circulation. 1996 Nov 1;94(9 SUPPL.):II278-II282.