Case Report DOI 10.3349/ymj.2009.50.4.588 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(4): 588-590, 2009 Permanent Pacemaker for Syncope after Heart Transplantation with Bicaval Technique Kyong Joo Lee,1 Yun Sook Jung,1 Chan Joo Lee,1 Jin Wi,1 Sanghoon Shin,1 Taehoon Kim,1 Sang Hak Lee,1 Seok-Min Kang,1 Moon-Hyoung Lee,1 and Han Ki Park2 Departments of 1Cardiology, 2Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea. Sinus node dysfunction occurs occasionally after heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy, and increasing donor age. However, the timing and indication of permanent pacemaker insertion due to sinus node dysfunction following heart transplantation is contentious. Here, we report a case of a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with a bicaval technique, which has been known to associate with few incidences of sinus node dysfunction. Key Words : Permanent pacemaker, sinus arrest, heart transplantation Received: October 31, 2007 Revised: December 14, 2007 Accepted: December 14, 2007 Corresponding author: Dr. Seok-Min Kang, Department of Cardiology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-8450, Fax: 82-2-393-2041 E-mail: smkang@yuhs.ac ∙The authors have no financial conflicts of interest. INTRODUCTION In the past, permanent pacemaker implantation is required in a large number of transplantation patients principally because of sinus node dysfunction of the donor atrium. However, the need for permanent pacemaker implantation after transplantation was nearly eliminated as surgical technique changed from standard biatrial anastomosis to bicaval anastomosis.1 This new bicaval anastomosis is technically simple and preserves the anatomic size, geometric configuration and physiologic function of the atria.2 Since 1992, we have performed bicaval technique in our all heart transplantation patients at our cardiovascular center. In this report, we present our first case of a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with bicaval technique. CASE REPORT A 44 year-old male visited our hospital because of shortness of breath and edema in both legs. He underwent prosthetic mitral valve replacement with Saint-Jude #27 due to severe mitral stenosis in 1992. He had no history of hypertension, diabetes mellitus and other diseases. On physical examination, enlarged liver was palpable with icteric sclera and neck veins were engorged. Metallic valve click sounds were audible without murmurs. Chest radiography showed marked cardiomegaly and no evidence of pulmonary edema. All laboratory findings were within normal limits except for mild elevation of total bilirubin level (2.7 mg/dL, normal range: 0.2 - 1.2 mg/dL). Abdominal sonography showed no remarkable © Copyright: Yonsei University College of Medicine 2009 588 Yonsei Med J http://www.eymj.org Volume 50 Number 4 August 2009