Cardiac allograft vasculopathy and donor age affecting permanent pacemaker implantation 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.

Automated summary

The need for permanent pacemakers after heart transplantation is increasing, and donor age, ischemic time, and pre-transplant amiodarone use are risk factors for early pacemaker implantation. Donor age and cardiac allograft vasculopathy (CAV) are risk factors for late pacemaker implantation. Late pacemaker implantation has a negative impact on survival, possibly indicating underlying progressive cardiac disease.