Key result
Advanced cardiac allograft vasculopathy linked to ~3.7-fold higher risk of late post-transplant pacemaker implantation.
Why the study?
The need for permanent pacemakers after heart transplantation is increasing, but the influence of cardiac allograft vasculopathy, donor age, and other risk factors on early and late implantation and survival remained unclear.
What are the risk factors for permanent pacemaker implantation after heart transplantation, and how does it affect survival?
Cohort (n=658)
No
What are the risk factors for permanent pacemaker implantation after heart transplantation, and how does it affect survival?
Hazard Ratio: 3.71 (95% CI 2.03–6.77)
p-value: p=<0.001
Late permanent pacemaker implantation after heart transplantation is strongly associated with cardiac allograft vasculopathy and significantly reduces survival, whereas early implantation does not.
Late PM implantation signals CAV and poorer survival post-transplant; warrants surveillance in high-risk recipients while leaving causal inference open in observational cohorts.
AIMS: The need for permanent pacemakers (PMs) after heart transplantation (HT) is increasing. The aim was to determine the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk factors on PM implantations early and late after HT and its effect on survival. METHODS AND RESULTS: A retrospective, single-centre study was performed including HTs from 1984 to July 2018. Early PM was defined as PM implantation ≤90 days and late PM as PM > 90 days. Risk factors for PM and survival after PM were determined with (time-dependent) multivariable Cox regression. Out of 720 HTs performed, 62 were excluded (55 mortalities ≤30 days and 7 retransplantations). Of the remaining 658 patients, 95 (14%) needed a PM: 38 (6%) early and 57 (9%) late during follow-up (median 9.3 years). Early PM risk factors were donor age [hazard ratio (HR) 1.06, P < 0.001], ischaemic time (HR 1.01, P < 0.001), and in adults amiodarone use before HT (HR 2.02, P = 0.045). Late PM risk factors were donor age (HR 1.03, P = 0.024) and CAV (HR 3.59, P < 0.001). Late PM compromised survival (HR 2.05, P < 0.001), while early PM did not (HR 0.77, P = 0.41). CONCLUSIONS: Risk factors for early PM implantation were donor age, ischaemic time, and in adults amiodarone use before HT. Late PM implantation risk factors were donor age and CAV. Late PM diminished survival, which is probably a surrogate marker for underlying progressive cardiac disease.
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Roest et al. (2022) conducted a cohort in Heart Transplantation (n=658). Cardiac allograft vasculopathy (CAV grade 2 or 3) vs. No or low-grade CAV was evaluated on Late permanent pacemaker implantation (>90 days post-transplant) (HR 3.71, 95% CI 2.03-6.77, p=<0.001). Cardiac allograft vasculopathy grade 2 or 3 significantly increased the risk of late permanent pacemaker implantation after heart transplantation (HR 3.71), which was associated with diminished survival.
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