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Pediatric heart transplantation—What are the risk factors for pacemaker implantation and how much pacing is required?
Author(s) -
Herrmann Florian Ernst Martin,
Wellmann Petra,
Hagl Christian,
Juchem Gerd
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13276
Subject(s) - medicine , cardiology , cardiac pacing , transplantation , heart transplantation , intensive care medicine
Abstract Background In an attempt to improve pacemaker therapy after pediatric transplantation, we investigated risk factors, indication for pacing, and pacing burden after pediatric heart transplantation. Methods and results In this retrospective study, 139 pediatric heart transplant recipients, of whom 122 did not and 17 did require pacemakers, were investigated. Eleven of the 17 patients requiring a permanent pacemaker (PPM) received their heart from a female donor (68.8%); this compares to 48 of 122 patients (43.2%, P = 0.082) in the group not requiring a pacemaker (No PPM). The donor age and height were significantly greater in the PPM group at a median of 25.26 years (16.29–48.00) and 160 cm (153–170) compared with 11.96 years (1.73–19.95) and 141 cm (89–165) in the No PPM group (P = 0.003 and 0.015, respectively). Of the 17 patients requiring pacemakers, 13 presented with sinus node dysfunction (SND) and four with atrioventricular block. The atrial pacing burden in patients with SND remained above 60% within the 5 years of follow‐up investigated. There was no significant difference in mortality between those patients requiring a PPM and those not (Log‐Rank test: P = 0.672). Conclusion We found that in our cohort donor characteristics were key risk factors for pacemaker implantation in transplanted children. The data suggest that when patients require a pacemaker in posttransplant SND, they will require a relevant amount of pacing for at least 5 years. The pacing burden after this point remains to be investigated. Mortality does not differ between pediatric heart transplant patients with and without pacemakers.