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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) 7

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