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Cardiac Implantable Electronic Devices Following Heart Transplantation
Ersilia M DeFilippis1, Geoffrey Rubin1, Maryjane A Farr1
1Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
JACC. Clinical Electrophysiology
|August 22, 2020
Summary
Permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) use in heart transplant recipients is reviewed. While PPM use has decreased, data on ICDs and sudden cardiac death in this population remain limited.
Area of Science:
- Cardiology
- Transplantation Medicine
- Electrophysiology
Background:
- Heart transplantation recipients may require permanent pacemakers (PPMs) for arrhythmias like sinus node dysfunction or atrioventricular block.
- The incidence of PPM implantation has declined with modern surgical techniques (bicaval anastomosis).
- Implantable cardioverter-defibrillators (ICDs) are used in a small percentage of these patients, with limited supporting data.
Purpose of the Study:
- To comprehensively analyze the existing data on PPM and ICD use in heart transplant recipients.
- To discuss the role of novel pacing and defibrillator technologies in this population.
- To identify special considerations and future research directions for device therapy post-transplant.
Main Methods:
- Systematic review of existing literature on PPM and ICD implantation in heart transplant patients.
- Analysis of cohort studies and case series regarding device efficacy and outcomes.
- Inclusion of data on leadless PPMs and subcutaneous ICDs.
Main Results:
- PPM implantation rates have decreased to <5% following bicaval anastomosis.
- Pacing dependence varies among patients.
- Sudden cardiac death occurs in ~10% of recipients, with nonarrhythmic causes often implicated.
Conclusions:
- PPMs and ICDs play a role in managing arrhythmias and preventing sudden cardiac death in heart transplant recipients.
- Further research is needed to establish optimal device strategies, especially for ICDs.
- Emerging technologies like leadless PPMs and subcutaneous ICDs warrant further investigation in this unique patient group.
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