Arrhythmias & electrophysiology
Long-Term Outcomes of Permanent Pacemaker Implantation in Bicaval Heart Transplant Recipients
Authors' conclusion
PPMs are implanted after HT for sinus and atrioventricular node dysfunctions with low incidence of device-related complications. Our study shows a decrease in PPM implantation after 2018, likely attributable to expectant management in the early postoperative period.
Study context
- Population
- Bicaval heart transplant recipients, Columbia University, January 2005–December 202141 (3.8%) received permanent pacemakers (PPMs)
- Participants
- 1,082 recipients
- Exposure
- PPM vs no PPM after bicaval heart transplantation (HT)
- Casesn = 41
- Outcome
- Re-transplantation or graft failure/death
- Follow-up
- 10 years post-HT
Methodological detailssingle-centre, matched by age, sex and year of transplantation
- Single-centre
- Matched by age, sex and year of transplantation
Main finding
As reported in the abstract
Death and re-transplantation
- Rates of death and re-transplantation at 10 years post-HT similar between groups
Observational data: associations, not effects.
Further findings
Time from HT to PPM
- Median time from transplantation to PPM, days (IQR 18-920)
- 118
PPM indications
- Sinus node dysfunction (n = 25)
- 60%
- Atrioventricular (AV) nodal disease (n = 17)
- 41.5%
Predictors of PPM implantation (multivariable)
- Only older donor age associated with increased risk of PPM implantation
- P = 0.03
- Adjusted for mechanical circulatory support, pretransplantation amiodarone use, donor ischemic time and age
PPM placement after vs before 2018
- Significant decrease in PPM placement after 2018 (1.2% vs 4.4%)
- P = 0.02
- Largely driven by a decline in early PPM placement
Safety
Post-implantation complications
- Pocket hematoma
- 3
- Lead under-sensing
- 2
- Pocket infection requiring explant
- 1
Original publication
Long-Term Outcomes of Permanent Pacemaker Implantation in Bicaval Heart Transplant Recipients. JACC Clin Electrophysiol. Published 19 July 2023. doi:10.
Summarised from the published abstract; every number is checked against it