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Titolo:
Optimal cardiac pacing after heart transplantation
Autore:
Melton, IC; Gilligan, DM; Wood, MA; Ellenbogen, KA;
Indirizzi:
Virginia Commonwealth Univ, Med Coll Virginia Hosp, Dept Cardiovasc Electrophysiol, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA McGuire VA Med Ctr, Richmond, VA USA McGuire VA Med Ctr Richmond VA USAMcGuire VA Med Ctr, Richmond, VA USA
Titolo Testata:
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
fascicolo: 10, volume: 22, anno: 1999,
pagine: 1510 - 1527
SICI:
0147-8389(199910)22:10<1510:OCPAHT>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
SINUS NODE DYSFUNCTION; SYMPATHETIC REINNERVATION; ATRIOVENTRICULAR-BLOCK; CHRONOTROPIC RESPONSIVENESS; ATRIOATRIAL CONDUCTION; REJECTION; ATRIAL; RECIPIENTS; EXERCISE; THEOPHYLLINE;
Keywords:
orthotopic cardiac transplantation; cardiac pacemaker; bradycardia; chronotropic incompetence;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
75
Recensione:
Indirizzi per estratti:
Indirizzo: Ellenbogen, KA Virginia Commonwealth Univ, Med Coll Virginia, POB 980053, Richmond, VA 23298 USA Virginia Commonwealth Univ POB 980053 Richmond VA USA 23298
Citazione:
I.C. Melton et al., "Optimal cardiac pacing after heart transplantation", PACE, 22(10), 1999, pp. 1510-1527

Abstract

The transplanted heart is characterized physiologically by autonomic denervation, chronotropic incompetence, intermittent episodes of allograft rejection, and frequently by diastolic dysfunction. Sinus node dysfunction resulting in bradycardia is common in the early postoperative period following standard orthotopic cardiac transplantation. Bradycardia fends to remit spontaneously but there are no factors that accurately identify patients who will need long-term pacing. Patients in whom bradycardia persists beyond the second postoperative week despite treatment with theophylline require permanent pacemaker implantation. It has been observed that chronotropic incompetence and diastolic dysfunction are important determinants of exercise capacity following heart transplantation. Pacing that restores chronotropic competence improves exercise capacity, confirming the importance of impaired heart rate response. As in other settings, pacing that preserves atrioventricular (AV) synchrony results in increased cardiac output. For these reasonswhen pacing is necessary we recommend the DDDR mode (AAIR if intact AV nodal conduction is present) so that the 30%-50% of patients who remain pacemaker-dependent long-term obtain maximal benefit from their transplant.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/11/20 alle ore 04:35:28