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Updated: Dec 26, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Permanent pacemaker implantation in pediatric heart transplant recipients: A systematic review and evidence quality
Konstantinos S Mylonas1,2, Theodoros Repanas3, Dimitrios I Athanasiadis4
1Department of Pediatric Cardiac Surgery, Mitera Children's Hospital, HYGEIA Group, Athens, Greece.
Insights
Permanent pacemaker implantation is rarely needed after pediatric heart transplants, with sinus node dysfunction being the main reason. Biatrial anastomosis may increase the likelihood of requiring a pacemaker in these young patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Bradyarrhythmias are a frequent complication post-pediatric orthotopic heart transplantation (OHT).
- Permanent pacemaker implantation (PPM) may be necessary for managing these arrhythmias.
Purpose of the Study:
- To determine the incidence, predictors, and outcomes of PPM implantation in children following OHT.
- To analyze factors influencing the need for pacemakers in this pediatric population.
Main Methods:
- A PRISMA-compliant systematic literature review was conducted using PubMed and Cochrane Library.
- Data from 11 studies involving 7198 pediatric patients undergoing OHT were analyzed.
- Quality assessment of included studies was performed using the Newcastle-Ottawa and Joanna Briggs Institute tools.
Main Results:
- PPM was implanted in 1.9% of pediatric OHT patients.
- Sinus node dysfunction (54.4%) and AV block (45.6%) were the primary indications for PPM.
- Biatrial anastomosis was associated with a higher likelihood of PPM requirement.
Conclusions:
- PPM implantation is uncommon after pediatric OHT.
- Sinus node dysfunction is the leading indication for pacing in this cohort.
- Surgical technique, specifically biatrial anastomosis, may be a predictor for PPM need.
Abstract:
Bradyarrhythmias are a common complication following pediatric OHT and may require permanent pacemaker implantation (PPM). The purpose of this study was to investigate the incidence, predictors, and outcomes of children undergoing PPM implantation following OHT. A PRISMA-compliant systematic literature review was performed using the PubMed database and the Cochrane Library (end-of-search date: January 27, 2019). The Newcastle-Ottawa scale and the Joanna Briggs Institute tool were used to assess the quality of cohort studies and case reports, respectively. We analyzed data from a total of 11 studies recruiting 7198 pediatric patients who underwent heart transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI: 1.6-2.2) of the patients. Most patients underwent dual-chamber pacing (46%, 95% CI: 32.6-59.7). Male-to-female ratio was 1.3:1. Mean patient age at the time of OHT was 10.1 ± 6.3. Overall, biatrial anastomosis was used in 62.2% (95% CI: 52.8-70.6) of the patients. The bicaval technique was performed in the remaining 37.8% (95% CI: 29.4-47.1). Sinus node dysfunction was the most frequent indication for PPM implantation (54.4%; 95% CI: 42.6-65.7) followed by AV block (45.6%; 95% CI: 34.3-57.3). The median time interval between OHT and PPM implantation ranged from 17 days to 12.5 years. All-cause mortality was 27.9% (95% CI: 18.6-39.6) during a median follow-up of 5 years. PPM implantation is rarely required after pediatric OHT. The most common indication for pacing is sinus node dysfunction, and patients undergoing biatrial anastomosis may be more likely to require PPM.
