心脏移植术后早期起搏器依赖与永久起搏器植入、移植物功能衰竭及死亡率相关。

Early Pacemaker Dependency After Heart Transplantation Is Associated with Permanent Pacemaker Implantation, Graft Failure and Mortality.

作者信息

Darche Fabrice F, Heil Karsten M, Rivinius Rasmus, Helmschrott Matthias, Ehlermann Philipp, Frey Norbert, Rahm Ann-Kathrin

机构信息

Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany.

Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, 69120 Heidelberg, Germany.

出版信息

J Cardiovasc Dev Dis. 2024 Dec 8;11(12):394. doi: 10.3390/jcdd11120394.

DOI:10.3390/jcdd11120394

PMID:39728284

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11679924/

Abstract

AIMS

Patients after heart transplantation (HTX) often experience post-transplant bradycardia, but little is known about the outcomes of early pacemaker dependency after HTX. We compared post-transplant mortality, graft failure, and the requirement for the permanent pacemaker implantation of patients with and without early pacemaker dependency after HTX.

METHODS

We screened all adult patients for early pacemaker dependency after HTX (defined as immediately after surgery) who underwent HTX at Heidelberg Heart Center between 1989 and 2022. Patients were stratified by diagnosis and type of early pacemaker dependency after HTX (sinoatrial or atrioventricular conduction disturbance).

RESULTS

A total of 127 of 699 HTX recipients (18.2%) had early pacemaker dependency after HTX, including 52 patients with sinoatrial conduction disturbances (40.9%) and 75 patients with atrioventricular conduction disturbances (59.1%). Patients with early pacemaker dependency after HTX showed both increased 1-year overall mortality after HTX (55.9% vs. 15.2%, < 0.001) and higher mortality due to graft failure (25.2% vs. 4.2%, < 0.001). Multivariate analysis revealed early pacemaker dependency after HTX (HR: 5.226, 95% CI: 3.738-7.304, < 0.001) as an independent risk factor for 1-year mortality after HTX. Patients with early pacemaker dependency after HTX had a higher rate of 30-day (7.1% vs. 0.4%, < 0.001) and 1-year (11.8% vs. 0.5%, < 0.001) permanent pacemaker implantation after HTX compared to patients without early pacemaker dependency after HTX.

CONCLUSIONS

Patients with early pacemaker dependency after HTX had a significantly higher rate of post-transplant mortality, graft failure, and the requirement for permanent pacemaker implantation.

摘要

目的

心脏移植（HTX）后的患者常出现移植后心动过缓，但关于HTX后早期起搏器依赖的结局知之甚少。我们比较了HTX后有和没有早期起搏器依赖的患者的移植后死亡率、移植物失败率以及永久起搏器植入的需求。

方法

我们对1989年至2022年在海德堡心脏中心接受HTX的所有成年患者进行筛查，以确定HTX后（定义为术后立即）的早期起搏器依赖情况。患者根据HTX后早期起搏器依赖的诊断和类型（窦房结或房室传导障碍）进行分层。

结果

699例HTX受者中共有127例（1８.2%）在HTX后有早期起搏器依赖，其中52例（40.9%）有窦房结传导障碍，75例（59.1%）有房室传导障碍。HTX后有早期起搏器依赖的患者在HTX后1年的总体死亡率（55.9%对15.2%，P<0.001）和因移植物失败导致的死亡率（25.2%对4.2%，P<0.001）均升高。多变量分析显示，HTX后早期起搏器依赖（HR：5.226，95%CI：3.738-7.304，P<0.001）是HTX后1年死亡率的独立危险因素。与HTX后没有早期起搏器依赖的患者相比，HTX后有早期起搏器依赖的患者在HTX后30天（7.1%对0.4%，P<0.001）和1年（11.8%对0.5%，P<0.001）的永久起搏器植入率更高。