Open AccessPermanent pacing in a very long‐term follow‐up after orthotopic heart transplantation: A matter of when or why?
Author(s) -
Alyaydin Emyal,
Pogoda Christian,
Dell'Aquila Angelo,
Frommeyer Gerrit,
Sindermann Juergen R.,
Reinecke Holger,
Tuleta Izabela
Publication year - 2022
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12979
Subject(s) - medicine , heart transplantation , cardiology , incidence (geometry) , transplantation , cardiac resynchronization therapy , heart failure , retrospective cohort study , population , implant , surgery , ejection fraction , physics , environmental health , optics
Background Orthotopic heart transplantation (OHT) is associated with a high incidence of conduction disturbances (CD) leading to permanent pacemaker (PPM) implantation. However, the improved posttransplant survival raises the question about the pacemaker dependence (PD) in a prolonged follow‐up. Hypothesis The prevalence of PPM in OHT is high but not all patients are PD in a very long‐term follow‐up. Device implantation has no prognostic relevance. Methods We performed a retrospective analysis of patient medical records focusing on device interrogation data at the most recent follow‐up. Results The study population consisted of 183 patients with a mean follow‐up of 15.0 ± 6.8 years. One‐fourth of the patients had undergone PPM implantation ( n = 49, 26.8%). Among these, two‐thirds were PD at last follow‐up ( n = 32, 65.3%). PPM was more often in biatrial OHT and cardiac allograft vasculopathy (OR 3.0, 95% CI 1.26–7.29, p = .013 and OR 2.0, 95% CI 1.03–3.87, p = .041, respectively). Early sinus node dysfunction (SND) was the most persistent CD. PPM was associated with a poorer outcome in OHT (HR 1.9, 95% CI 1.06–3.46, p = .031) and a higher rate of fatal septicemia (HR 5.1, 95% CI 1.41–18.14, p = .013). Conclusions One‐fourth of the OHT recipients develop CD requiring PPM implantation, although one‐third among these are not PD in follow‐up. Early SND is associated with a higher rate of PD. PPM is associated with an inferior prognosis.