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Implantation of the Syncardia Total Artificial Heart
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Heart Transplantation Requiring Permanent Pacemaker: Risk Factors and Outcomes.

Michael Keller1, Ye In Christopher Kwon1, Yashar Haghighi1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.

Journal of Clinical Medicine
|July 15, 2026
PubMed
Summary

Permanent pacemaker (PPM) implantation after heart transplantation (HT) is not linked to increased mortality. Early PPM showed lower graft failure and primary graft dysfunction, while late PPM had short-term survival impacts but not long-term.

Keywords:
donation after cardiac deathheart transplantationpacemaker

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Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Devices

Background:

  • A subset of heart transplant recipients require permanent pacemakers (PPM).
  • Understanding risk factors and outcomes for PPM implantation post-heart transplantation (HT) is crucial.

Purpose of the Study:

  • To explore risk factors and outcomes associated with early (pre-discharge) and late (>6 months post-transplant) PPM implantation in adult HT recipients.
  • To assess the impact of PPM implantation on recipient survival and graft function.

Main Methods:

  • Utilized the United Network for Organ Sharing (UNOS) database (2013-2023) for adult HT patients receiving early or late PPM.
  • Employed propensity score matching (PSM) for control cohorts.
  • Analyzed recipient survival, graft failure, primary graft dysfunction (PGD), and mortality using Cox and logistic regression, and Kaplan-Meier curves.

Main Results:

  • Early PPM recipients (n=354) demonstrated similar survival but lower graft failure and PGD rates compared to controls.
  • Late PPM recipients (n=554) showed reduced short-term survival (30 days, 1 year) but not at 5 years.
  • Neither early nor late PPM independently increased mortality risk post-HT; Donation after Circulatory Death (DCD) organs correlated with lower early PPM risk.

Conclusions:

  • Permanent pacemaker implantation, whether early or late, is not an independent predictor of mortality following heart transplantation.
  • Distinct short-term morbidity and mortality profiles exist between early and late PPM implantation groups.
  • Further investigation into the specific mechanisms driving these observed differences is warranted.