{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:53:55Z","timestamp":1791258835108,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Early postoperative heart rate (HR) management after heart transplantation (HTx) remains largely guided by historical haemodynamic concepts that support maintaining elevated HR to compensate for reduced stroke volume. This structured narrative review re\u2010examines the physiological rationale and contemporary evidence underlying this approach, with the aim of refining perioperative chronotropic strategies. A comprehensive analysis of studies addressing early HR behavior, sinus node dysfunction (SND), pacing strategies, chronotropic therapies, and their association with clinical outcomes was performed. Classic studies from the 1970s described marked stroke\u2010volume depression and a strong dependence of cardiac output on HR, forming the basis for maintaining HR around 90\u2013100\u00a0bpm. However, contemporary evidence indicates a more heterogeneous early graft physiology, often with less pronounced stroke\u2010volume limitation, and highlights potential adverse effects associated with excessive adrenergic stimulation, including renal dysfunction and worse mid\u2010term outcomes. SND is common but typically transient, and atrial or atrioventricular\u2010synchronous pacing can restore HR without the metabolic burden of \u03b2\u2010adrenergic stimulation. In contrast, isoproterenol provides combined chronotropic and inotropic support but may increase myocardial oxygen consumption, shorten diastolic filling time, and impair right ventricular\u2013pulmonary artery coupling when perfusion pressure is inadequate. Integration of perfusion markers, such as lactate and central venous oxygen saturation, with echocardiographic and invasive haemodynamic assessment is essential to determine whether HR augmentation improves oxygen delivery or instead increases metabolic stress. Early HR management after HTx should therefore be individualized and guided by integrated physiological assessment rather than fixed HR targets. Prospective studies are needed to define evidence\u2010based chronotropic strategies.<\/jats:p>","DOI":"10.1111\/ctr.70710","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:43:00Z","timestamp":1791258180000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the 100\u2010bpm Dogma: A Physiology\u2010Guided Approach to Early Postoperative Heart Rate Management After Heart Transplantation"],"prefix":"10.1111","volume":"40","author":[{"given":"Federico","family":"Franchi","sequence":"first","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit University Hospital of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Marianello","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit University Hospital of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit University Hospital of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Biuzzi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Neurosciences, Anesthesia and Intensive Care Unit University Hospital of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Gottin","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit University Hospital of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Peluso","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit University Hospital of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Maccherini","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Division of Cardiac Surgery University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cameli","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Vendramin","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabino","family":"Scolletta","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Neurosciences, Anesthesia and Intensive Care Unit University Hospital of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Sponga","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Surgery and Neurosciences, Division of Cardiac Surgery University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"5","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients","volume":"42","author":"Velleca A.","year":"2023","journal-title":"The Journal of Heart and Lung Transplantation"},{"issue":"8","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.healun.2010.05.034","article-title":"The International Society of Heart and Lung Transplantation Guidelines for the Care of Heart Transplant Recipients","volume":"29","author":"Costanzo M. 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