Permanent pacemaker implantation early and late after heart transplantation : clinical indication, risk factors and prognostic implications
Jones, David G ; Mortsell, David H LU
; Rajaruthnam, Direndra
; Hamour, Iman
; Hussain, Wajid
; Markides, Vias
; Banner, Nicholas R
and Wong, Tom
(2011)
In The Journal of Heart and Lung Transplantation
30(11).
p.65-1257
- Abstract
BACKGROUND: Permanent pacemaker implantation (PPM) early after cardiac transplantation has been shown not to predict a worse outcome. However, the requirement for pacing late after transplantation and its prognostic implications are not fully known. We describe the clinical indications, risk factors and long-term outcome in patients who required pacing early and late after transplantation.
METHODS: The transplant database, medical records and pacing database/records were reviewed for all patients undergoing de novo orthotopic cardiac transplantation (n = 389) at our institution between January 1995 and May 2006.
RESULTS: A total of 48 patients (12.3%) received a pacemaker after transplantation. Of these patients, 30 were... (More)
BACKGROUND: Permanent pacemaker implantation (PPM) early after cardiac transplantation has been shown not to predict a worse outcome. However, the requirement for pacing late after transplantation and its prognostic implications are not fully known. We describe the clinical indications, risk factors and long-term outcome in patients who required pacing early and late after transplantation.
METHODS: The transplant database, medical records and pacing database/records were reviewed for all patients undergoing de novo orthotopic cardiac transplantation (n = 389) at our institution between January 1995 and May 2006.
RESULTS: A total of 48 patients (12.3%) received a pacemaker after transplantation. Of these patients, 30 were paced early, pre-hospital discharge (25 ± 19 days post-transplantation), and 18 patients had late pacing (3.0 ± 3.3 years post-transplantation). There were no differences in clinical characteristics, use of anti-arrhythmic drugs or length-of-stay post-transplantation between early and late groups. Early indications for pacing were more often sino-atrial (SA) disease (24 of 30, 80%), whereas atrio-ventricular (AV) disease was more likely to occur later (p = 0.03). Risk factors for PPM included use of biatrial anastomosis (p = 0.001) and donor age (p = 0.002). Prior rejection was a univariate but not multivariate (p = 0.09) predictor of the need for PPM. Development of cardiac allograft vasculopathy was not predictive. There was no significant difference in mortality between late and early PPM patients or between late PPM patients and the non-paced patients who survived transplantation and initial stay.
CONCLUSIONS: Patients who required PPM late after orthotopic cardiac transplantation had a prognosis comparable to those paced early and those who did not require PPM. The independent risk factors for PPM were biatrial anastomosis and increasing donor age. SA-nodal dysfunction as an indication for PPM was more prevalent early after transplantation, whereas atrioventricular (AV) disease more commonly presented late. The requirement for pacing late after transplantation was not associated with rejection or cardiac allograft vasculopathy.
(Less)
- author
- Jones, David G
; Mortsell, David H
LU
; Rajaruthnam, Direndra
; Hamour, Iman
; Hussain, Wajid
; Markides, Vias
; Banner, Nicholas R
and Wong, Tom
- publishing date
- 2011-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Bradycardia/epidemiology, Electrodes, Implanted, Female, Follow-Up Studies, Heart Diseases/surgery, Heart Transplantation/adverse effects, Humans, Incidence, Male, Middle Aged, Pacemaker, Artificial, Postoperative Period, Prognosis, Retrospective Studies, Risk Factors, Survival Rate/trends, Time Factors, Transplantation, Homologous, United Kingdom/epidemiology
- in
- The Journal of Heart and Lung Transplantation
- volume
- 30
- issue
- 11
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:21783383
- scopus:80054001154
- ISSN
- 1557-3117
- DOI
- 10.1016/j.healun.2011.05.010
- language
- English
- LU publication?
- no
- additional info
- 2011. Published by Elsevier Inc.
- id
- 41690335-391e-4d59-a458-24a9a6435ef6
- date added to LUP
- 2019-06-03 19:41:13
- date last changed
- 2024-06-26 19:50:24
@article{41690335-391e-4d59-a458-24a9a6435ef6,
abstract = {{<p>BACKGROUND: Permanent pacemaker implantation (PPM) early after cardiac transplantation has been shown not to predict a worse outcome. However, the requirement for pacing late after transplantation and its prognostic implications are not fully known. We describe the clinical indications, risk factors and long-term outcome in patients who required pacing early and late after transplantation.</p><p>METHODS: The transplant database, medical records and pacing database/records were reviewed for all patients undergoing de novo orthotopic cardiac transplantation (n = 389) at our institution between January 1995 and May 2006.</p><p>RESULTS: A total of 48 patients (12.3%) received a pacemaker after transplantation. Of these patients, 30 were paced early, pre-hospital discharge (25 ± 19 days post-transplantation), and 18 patients had late pacing (3.0 ± 3.3 years post-transplantation). There were no differences in clinical characteristics, use of anti-arrhythmic drugs or length-of-stay post-transplantation between early and late groups. Early indications for pacing were more often sino-atrial (SA) disease (24 of 30, 80%), whereas atrio-ventricular (AV) disease was more likely to occur later (p = 0.03). Risk factors for PPM included use of biatrial anastomosis (p = 0.001) and donor age (p = 0.002). Prior rejection was a univariate but not multivariate (p = 0.09) predictor of the need for PPM. Development of cardiac allograft vasculopathy was not predictive. There was no significant difference in mortality between late and early PPM patients or between late PPM patients and the non-paced patients who survived transplantation and initial stay.</p><p>CONCLUSIONS: Patients who required PPM late after orthotopic cardiac transplantation had a prognosis comparable to those paced early and those who did not require PPM. The independent risk factors for PPM were biatrial anastomosis and increasing donor age. SA-nodal dysfunction as an indication for PPM was more prevalent early after transplantation, whereas atrioventricular (AV) disease more commonly presented late. The requirement for pacing late after transplantation was not associated with rejection or cardiac allograft vasculopathy.</p>}},
author = {{Jones, David G and Mortsell, David H and Rajaruthnam, Direndra and Hamour, Iman and Hussain, Wajid and Markides, Vias and Banner, Nicholas R and Wong, Tom}},
issn = {{1557-3117}},
keywords = {{Bradycardia/epidemiology; Electrodes, Implanted; Female; Follow-Up Studies; Heart Diseases/surgery; Heart Transplantation/adverse effects; Humans; Incidence; Male; Middle Aged; Pacemaker, Artificial; Postoperative Period; Prognosis; Retrospective Studies; Risk Factors; Survival Rate/trends; Time Factors; Transplantation, Homologous; United Kingdom/epidemiology}},
language = {{eng}},
number = {{11}},
pages = {{65--1257}},
publisher = {{Elsevier}},
series = {{The Journal of Heart and Lung Transplantation}},
title = {{Permanent pacemaker implantation early and late after heart transplantation : clinical indication, risk factors and prognostic implications}},
url = {{http://dx.doi.org/10.1016/j.healun.2011.05.010}},
doi = {{10.1016/j.healun.2011.05.010}},
volume = {{30}},
year = {{2011}},
}