Understanding the role of temporary epicardial pacemakers after heart transplantation in the cardiac intensive care unit

The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients recommend the placement of temporary epicardial pacing wires at the time of surgery. However, there is little data regarding optimal postoperative pacing modality and its implications on intensive care unit (ICU) length of stay (LOS). We conducted a single-center retrospective cohort study of 187 patients who underwent heart transplantation from January 1, 2019 to February 28, 2023 and had postoperative epicardial pacemaker wires placed. The study's primary outcome was to observe the association between pacing modalities and prolonged ICU LOS (greater than 5 days). The secondary outcome was to observe the association between pacing modalities and prolonged hospital LOS (greater than 15 days), readmission within 30 days of discharge, days on inotropic and pressor support, death, high-grade rejection on biopsy, coronary artery vasculopathy at 1 year, primary graft dysfunction, mediastinitis, and development of a malignancy. Twenty-two patients (12%) had their pacing mode turned off at the time of arrival to the ICU, 36 patients (19%) had their pacing mode set to atrially paced, atrially sensed, inhibit, 101 patients (54%) had theirs set to dual chamber paced, dual chamber sensed, triger/inhibit sensed events, and 28 (15%) had theirs set to ventricularly paced, ventricularly sensed, inhibit. No mode of epicardial pacing was associated with an increased ICU LOS, hospital LOS, increased readmission rates, increased short-term adverse effects, increased long-term adverse effects, or increased duration of support with vasoactive medications. Our study demonstrated no significant association between the mode of temporary pacing and LOS or adverse effects after heart transplantation.