Early or late permanent pacemaker implantation after heart transplantation was not an independent risk factor for mortality, despite late PPM being associated with reduced short-term survival.
Cohort (n=908)
Yes
Does permanent pacemaker implantation (early or late) affect survival in adult heart transplant recipients?
Permanent pacemaker implantation after heart transplantation is not an independent risk factor for long-term mortality, despite some differences in short-term survival and morbidity.
p-value: p=0.582, 0.421, 0.2844 (early); <0.001, 0.0023, 0.050 (late)
Background/Objectives: Following heart transplantation (HT), a subset of patients will require an early or late permanent pacemaker (PPM). We explored risk factors and outcomes associated with PPM implantation in this population. Methods: Using the United Network for Organ Sharing (UNOS) database, we identified all adult patients undergoing HT from 2013 to 2023 who received a PPM early (prior to discharge) or late (>6 months post transplant). Propensity score matching (PSM) was used for control cohorts was. Primary outcomes included recipient survival at 30 days and 1 and 5 years. Predictors of early and late PPM, as well as post-PPM mortality, were assessed using Cox and logistic regression models. Kaplan–Meier survival curves were compared using a log-rank test. Results: Following PSM, the early PPM cohort included 354 patients, and the late PPM cohort included 554 patients. Early PPM patients showed similar 30-day and 1- and 5-year survival (p = 0.582, 0.421, and 0.2844 respectively) but lower rates of graft failure (1.1% vs. 4%, p = 0.017) and primary graft dysfunction (PGD) (1.7% vs. 4.2%, p = 0.046). Late PPM patients had reduced survival at 30 days and 1 year but not at 5 years (p < 0.001, p = 0.0023, 0.050 respectively). Neither early nor late PPM was independently associated with increased risk of mortality after HT. Donation after Circulatory Death (DCD) organs were associated with a lower risk of early PPM (aOR = 0.409, p = 0.020). Late PPM patients showed higher rates of PGD (2.5% vs. 0.5%, p = 0.007). Conclusions: Early or late PPM is not an independent risk factor for mortality after HT, but differing short-term morbidity and mortality are observed.
Keller et al. (Mer,) ont mené une cohorte en transplantation cardiaque nécessitant un stimulateur cardiaque permanent (n=908). L'implantation de stimulateur cardiaque permanent (PPM) (précoce ou tardive) par rapport à des témoins appariés par score de propension sans PPM a été évaluée sur la survie des receveurs à 30 jours, 1 an et 5 ans (p=0.582, 0.421, 0.2844 (précoce); <0.001, 0.0023, 0.050 (tardive)). L'implantation précoce ou tardive de stimulateur cardiaque permanent après transplantation cardiaque n'était pas un facteur de risque indépendant de mortalité, malgré le fait que le PPM tardif soit associé à une survie à court terme réduite.