Early Pacemaker Dependency After Heart Transplantation Is Associated with Permanent Pacemaker Implantation, Graft Failure and Mortality

Aims: Patients after heart transplantation (HTX) often experience post-transplant bradycardia, but little is known about the outcomes of early pacemaker dependency after HTX. We compared post-transplant mortality, graft failure, and the requirement for the permanent pacemaker implantation of patients with and without early pacemaker dependency after HTX. Methods: We screened all adult patients for early pacemaker dependency after HTX (defined as immediately after surgery) who underwent HTX at Heidelberg Heart Center between 1989 and 2022. Patients were stratified by diagnosis and type of early pacemaker dependency after HTX (sinoatrial or atrioventricular conduction disturbance). Results: A total of 127 of 699 HTX recipients (18.2%) had early pacemaker dependency after HTX, including 52 patients with sinoatrial conduction disturbances (40.9%) and 75 patients with atrioventricular conduction disturbances (59.1%). Patients with early pacemaker dependency after HTX showed both increased 1-year overall mortality after HTX (55.9% vs. 15.2%, p < 0.001) and higher mortality due to graft failure (25.2% vs. 4.2%, p < 0.001). Multivariate analysis revealed early pacemaker dependency after HTX (HR: 5.226, 95% CI: 3.738–7.304, p < 0.001) as an independent risk factor for 1-year mortality after HTX. Patients with early pacemaker dependency after HTX had a higher rate of 30-day (7.1% vs. 0.4%, p < 0.001) and 1-year (11.8% vs. 0.5%, p < 0.001) permanent pacemaker implantation after HTX compared to patients without early pacemaker dependency after HTX. Conclusions: Patients with early pacemaker dependency after HTX had a significantly higher rate of post-transplant mortality, graft failure, and the requirement for permanent pacemaker implantation.