Early permanent pacemaker implantation after heart transplantation was associated with inferior 5-year survival compared to late or no pacemaker implantation (P<0.01).
Cohort (n=621)
No
What are the risk factors for permanent pacemaker implantation after heart transplantation, and does it affect 5-year post-transplant survival?
In heart transplant recipients, higher recipient BMI, older donor age, and biatrial surgical technique increase the risk of needing a permanent pacemaker, and early pacemaker implantation is associated with worse 5-year survival driven by infections.
Effect estimate: HR 2.63 (95% CI 1.22-5.68)
p-value: p=0.01
BACKGROUND: Permanent pacemaker (PPM) implantation after heart transplantation (HTX) may be required due to severe bradycardia. The aim of this study was to investigate the risk factors, indications, perioperative outcomes and complications of PPM implantation after HTX as well as the underlying effect on post-transplant mortality including causes of death. METHODS: This registry study included 621 patients receiving HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by PPM implantation after HTX. Data analysis of risk factors for PPM implantation included donor and recipient demographics, post-transplant medication, mortality, and causes of death. RESULTS: Thirty-six patients (5.8%) received PPM implantation after HTX, 12 (33.3%) with early PPM and 24 (66.7%) with late PPM. Indications for PPM implantation after HTX included sinus node dysfunction (SND) (n=15; 41.7%) and atrioventricular block (AVB) (n=21; 58.3%). Multivariate analysis revealed recipient body mass index (BMI) hazard ratio (HR): 1.10; confidence interval (CI): 1.01-1.21; P=0.03, donor age (HR: 1.07; CI: 1.03-1.10; P<0.01), and biatrial HTX (HR: 2.63; CI: 1.22-5.68; P=0.01) as significant risk factors for PPM implantation after HTX. Kaplan-Meier estimator displayed a statistically significant inferior 5-year post-transplant survival among patients with early PPM after HTX in comparison to patients with late PPM or no PPM after HTX (P<0.01) along with a higher percentage of death due to infection (P<0.01). CONCLUSIONS: Multivariate risk factors for PPM implantation after HTX include recipient BMI, donor age, and biatrial HTX. Early PPM implantation after HTX is associated with increased 5-year post-transplant mortality due to infection.
Rivinius et al. (Sun,) conducted a cohort in Heart transplantation (n=621). Permanent pacemaker implantation vs. No permanent pacemaker implantation was evaluated on Permanent pacemaker implantation after heart transplantation (risk factor: biatrial HTX) (HR 2.63, 95% CI 1.22-5.68, p=0.01). Early permanent pacemaker implantation after heart transplantation was associated with inferior 5-year survival compared to late or no pacemaker implantation (P<0.01).
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