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Cardiac allograft vasculopathy and donor age affecting permanent pacemaker implantation after heart transplantation
Stefan Roest1,2, Olivier C Manintveld1,2, Marit A E Kolff1,2
1Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
Permanent pacemaker (PM) implantation after heart transplantation (HT) is rising. Late PM, associated with cardiac allograft vasculopathy (CAV), negatively impacts survival, unlike early PM.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- The incidence of permanent pacemaker (PM) implantation following heart transplantation (HT) is increasing.
- Understanding risk factors for PM implantation and their impact on patient outcomes is crucial for improving post-transplant care.
Purpose of the Study:
- To investigate the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk factors on early and late PM implantations after HT.
- To evaluate the effect of early and late PM implantation on patient survival post-HT.
Main Methods:
- A retrospective single-centre study analyzed data from 658 heart transplant recipients between 1984 and 2018.
- Risk factors for early (≤90 days) and late (>90 days) PM implantation were identified using multivariable Cox regression.
- Survival outcomes were analyzed in relation to PM implantation timing.
Main Results:
- Of 658 patients, 95 (14%) required a PM: 38 early (6%) and 57 late (9%).
- Early PM risk factors included donor age, ischemic time, and pre-HT amiodarone use (adults).
- Late PM risk factors were donor age and CAV; late PM significantly compromised survival (HR 2.05), while early PM did not.
Conclusions:
- Donor age and ischemic time are key risk factors for early PM implantation post-HT.
- Cardiac allograft vasculopathy (CAV) and donor age are significant risk factors for late PM implantation.
- Late PM implantation serves as a marker for progressive cardiac disease and is associated with diminished survival after heart transplantation.
Aims:
The need for permanent pacemakers (PMs) after heart transplantation (HT) is increasing. The aim was to determine the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk factors on PM implantations early and late after HT and its effect on survival.
Methods And Results:
A retrospective, single-centre study was performed including HTs from 1984 to July 2018. Early PM was defined as PM implantation ≤90 days and late PM as PM > 90 days. Risk factors for PM and survival after PM were determined with (time-dependent) multivariable Cox regression. Out of 720 HTs performed, 62 were excluded (55 mortalities ≤30 days and 7 retransplantations). Of the remaining 658 patients, 95 (14%) needed a PM: 38 (6%) early and 57 (9%) late during follow-up (median 9.3 years). Early PM risk factors were donor age [hazard ratio (HR) 1.06, P < 0.001], ischaemic time (HR 1.01, P < 0.001), and in adults amiodarone use before HT (HR 2.02, P = 0.045). Late PM risk factors were donor age (HR 1.03, P = 0.024) and CAV (HR 3.59, P < 0.001). Late PM compromised survival (HR 2.05, P < 0.001), while early PM did not (HR 0.77, P = 0.41).
Conclusions:
Risk factors for early PM implantation were donor age, ischaemic time, and in adults amiodarone use before HT. Late PM implantation risk factors were donor age and CAV. Late PM diminished survival, which is probably a surrogate marker for underlying progressive cardiac disease.
