Pacing After Cardiac Transplantation
Key Point
ÎÎThe incidence of bradyarrhythmias after cardiac transplantation varies
from 8% to 23%.
Treatment
ÎÎPermanent pacing is indicated for:
• persistent inappropriate or symptomatic bradycardia not expected to resolve and
for other Class I indications for permanent pacing. (I-C)
ÎÎPermanent pacing may be considered:
• when relative bradycardia is prolonged or recurrent, which limits rehabilitation or
discharge after postoperative recovery from cardiac transplantation. (IIb-C)
• for syncope after cardiac transplantation even when bradyarrhythmia has not been
documented. (IIb-C)
Permanent Pacemakers That Automatically Detect and Pace to
Terminate Tachycardias
Treatment
ÎÎPermanent pacing is reasonable for:
• symptomatic recurrent supraventricular tachycardia (SVT) that is reproducibly
terminated by pacing when catheter ablation and/or drugs fail to control the
arrhythmia or produce intolerable side effects. (IIa-C)
ÎÎPermanent pacing is NOT indicated:
• in the presence of an accessory pathway that has the capacity for rapid anterograde
conduction. (III-C)
Pacing to Prevent Tachycardia
Treatment
ÎÎPermanent pacing is indicated for:
• sustained pause-dependent VT, with or without QT prolongation. (I-C)
ÎÎPermanent pacing is reasonable for:
• high-risk patients with congenital long-QT syndrome. (IIa-C)
ÎÎPermanent pacing may be considered for:
• prevention of symptomatic, drug-refractory, recurrent AF in patients with
coexisting SND. (IIb-B)
ÎÎPermanent pacing is NOT indicated for:
• frequent or complex ventricular ectopic activity without sustained VT in the
absence of the long-QT syndrome. (III-C)
• torsade de pointes VT due to reversible causes. (III-A)
Pacing to Prevent Atrial Fibrillation
Treatment
ÎÎPermanent pacing is NOT indicated for:
• the prevention of AF in patients without any other indication for pacemaker
implantation. (III-B)
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