Permanent pacing after cardiac transplantation in the era of extended donors
Related Experiment Video
Updated: Jul 20, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Shelley Zieroth1, Heather Ross, Vivek Rao
1Division of Cardiology and Transplant, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Background:
Early results with bicaval anastomosis have shown a decreased requirement for permanent pacing (PPM) after transplantation (Tx). It is unclear whether this remains true in the current era of extended donor criteria. The objective of the present study was to characterize the need for post-Tx PPM requirements in the current bicaval era and to determine factors associated with need for pacing.
Methods:
The local cardiac Tx database, hospital records and electrophysiology laboratory database were cross-referenced for information on patients in the pre-, peri- and post-Tx period.
Results:
Between 2000 and 2004, 88 patients received a cardiac Tx using bicaval anastomosis. At post-Tx, 18 of 88 (20.5%) patients required a PPM. The incidence of single- and dual-chamber PPM was 31.3% and 68.7%, respectively. Mean donor age for patients requiring post-Tx PPM was 44.7 +/- 15.3 years compared with 35.7 +/- 14.4 years for those with no PPM requirement (p = 0.019). For every 5-year increase in donor age the risk for post-Tx PPM increased 1.234-fold (95% confidence interval [CI] 1.022 to 1.489, p = 0.0289). Recipient age, gender, amiodarone use, year of transplant, surgeon and surgical times were not associated with PPM requirements after cardiac Tx.
Conclusions:
Pacing requirements after heart transplantation, in the era of extended donor criteria, exceed the previously published rates of 0% to 5%. The advantage of bicaval anastomosis in decreasing pacing needs post-Tx does not exist in the era of extended donor criteria, specifically in the older donor age group.
