Terbutaline for Management of Relative Bradycardia Post-Orthotopic Heart Transplant: A Single Center Experience

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-25 DOI:10.1111/ctr.70036

Zoe H. Tu, Allison N. Yun, Janardhana Gorthi, Ashrith Guha, Jill C. Krisl, Arvind Bhimaraj

{"title":"Terbutaline for Management of Relative Bradycardia Post-Orthotopic Heart Transplant: A Single Center Experience","authors":"Zoe H. Tu, Allison N. Yun, Janardhana Gorthi, Ashrith Guha, Jill C. Krisl, Arvind Bhimaraj","doi":"10.1111/ctr.70036","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post-operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long-term terbutaline use post-heart transplant.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post-transplant, adverse event rates, and permanent pacemaker (PPM) placement rates.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post-heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long-term sequelae. At 3 months post-transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post-heart transplant recipients. If patients require long-term chronotropic support, the risk-benefit of PPM placement versus continued terbutaline should be considered.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70036","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post-operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long-term terbutaline use post-heart transplant.

Methods

This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post-transplant, adverse event rates, and permanent pacemaker (PPM) placement rates.

Results

In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post-heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long-term sequelae. At 3 months post-transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant.

Conclusion

This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post-heart transplant recipients. If patients require long-term chronotropic support, the risk-benefit of PPM placement versus continued terbutaline should be considered.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

特布他林治疗异位心脏移植术后相对性心动过缓：单中心经验

背景在心脏移植过程中进行迷走神经去神经支配会导致受者的静息心率高于普通人群。相对心动过缓（RB）是一种常见的术后并发症，通常是暂时性的，可以使用特布他林等药物进行控制；然而，关于心脏移植术后长期使用特布他林的有效性、安全性和必要性的数据却很少。方法这是一项单中心、回顾性、描述性研究，在一家大型学术医疗中心进行，调查心脏移植受者口服特布他林治疗 RB 的情况。研究结果包括移植后停用特布他林的时间和原因、不良事件发生率和永久起搏器（PPM）安置率。结果在纳入的 229 例患者中，开始使用特布他林的中位数（IQR）时间为心脏移植后 8（5，12）天，停用特布他林的中位数（IQR）时间为首次给药后 56（20，96）天。在大多数病例中，特布他林可在门诊成功减量，原因是RB症状缓解。29例（12.7%）患者发生了快速性心律失常，但没有留下长期后遗症。移植后 3 个月时，15 名患者（6.6%）植入了 PPM 以获得慢性心动过速支持，植入 PPM 的中位时间（IQR）为移植后 24 天（19，77）。结论本研究的 PPM 置入率总体较低，这表明早期窦房结功能障碍可通过药物疗法治疗，而无需使用永久性装置，并且特布他林可安全地用于心脏移植后的早期受者。如果患者需要长期的促时差支持，则应考虑置入 PPM 与继续使用特布他林的风险效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.