Paroxysmal atrioventricular block after heart transplantation in children: an early sign of rejection?

Grutter, Giorgia; Alfieri, Sara; Calcagni, Giulio; Castelluzzo, Maria Assunta; Silvetti, Massimo Stefano; Parisi, Francesco; Drago, Fabrizio

doi:10.1111/petr.12832

Cited by 5 publications

(5 citation statements)

References 11 publications

(14 reference statements)

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“…Compared to the No PPM group, the rate of CAV was 12.5% greater in the PPM group; however, no statistical difference could be demonstrated (possibly due to a certain amount of missing data which could not be collected). Episodes of rejection have also been associated with the development of bradycardias, especially ABV . In our investigation, we were also not able to detect an association between clinically relevant rejection requiring acute therapy and PPM requirement.…”

Section: Discussioncontrasting

confidence: 85%

Pediatric heart transplantation—What are the risk factors for pacemaker implantation and how much pacing is required?

Herrmann

Wellmann

Hagl

et al. 2018

Pacing Clinical Electrophis

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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.

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Section: Discussioncontrasting

confidence: 85%

Pediatric heart transplantation—What are the risk factors for pacemaker implantation and how much pacing is required?

Herrmann

Wellmann

Hagl

et al. 2018

Pacing Clinical Electrophis

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“…Overall, 14 studies satisfied the predetermined search criteria (Figure 1). Two papers from the Baylor College of Medicine (Texas, United States) and another two from Ludwig Maximilian University (Munich, Germany) had overlapping populations, and a synthesis of their respective data was performed. Furthermore, two analyses of the UNOS database were also identified .…”

Section: Resultsmentioning

confidence: 99%

“…Since these registry studies had overlapping populations, we only included the study by El‐Assaad et al which specifically focused on PPM needs following pediatric heart transplant . Therefore, a total of 11 studies were ultimately included in our systematic review …”

Section: Resultsmentioning

confidence: 99%

Permanent pacemaker implantation in pediatric heart transplant recipients: A systematic review and evidence quality assessment

Mylonas

Repanas

Athanasiadis

et al. 2020

Pediatric Transplantation

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Bradyarrhythmias are a common complication following pediatric OHT and may require permanent pacemaker implantation (PPM). The purpose of this study was to investigate the incidence, predictors, and outcomes of children undergoing PPM implantation following OHT. A PRISMA‐compliant systematic literature review was performed using the PubMed database and the Cochrane Library (end‐of‐search date: January 27, 2019). The Newcastle‐Ottawa scale and the Joanna Briggs Institute tool were used to assess the quality of cohort studies and case reports, respectively. We analyzed data from a total of 11 studies recruiting 7198 pediatric patients who underwent heart transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI: 1.6‐2.2) of the patients. Most patients underwent dual‐chamber pacing (46%, 95% CI: 32.6‐59.7). Male‐to‐female ratio was 1.3:1. Mean patient age at the time of OHT was 10.1 ± 6.3. Overall, biatrial anastomosis was used in 62.2% (95% CI: 52.8‐70.6) of the patients. The bicaval technique was performed in the remaining 37.8% (95% CI: 29.4‐47.1). Sinus node dysfunction was the most frequent indication for PPM implantation (54.4%; 95% CI: 42.6‐65.7) followed by AV block (45.6%; 95% CI: 34.3‐57.3). The median time interval between OHT and PPM implantation ranged from 17 days to 12.5 years. All‐cause mortality was 27.9% (95% CI: 18.6‐39.6) during a median follow‐up of 5 years. PPM implantation is rarely required after pediatric OHT. The most common indication for pacing is sinus node dysfunction, and patients undergoing biatrial anastomosis may be more likely to require PPM.

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“…Prolonged PR interval, another type of conduction abnormality, was linked to conduction system fibrosis, and graft rejection 1022. Some studies reported AV block was associated with a higher risk of graft rejection, which resulted from lymphocyte infiltration, inflammation, myocyte necrosis or fibrosis at the conduction system 23242526. Furthermore, Calzolari, et al8 reported that appearance of first-degree AV block in a HT recipient may be suggestive of involvement of the conduction system with impending third-degree block.…”

Section: Discussionmentioning

confidence: 99%

Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation

Kim

et al. 2019

Yonsei Med J

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Purpose We aimed to examine associations between right bundle branch block (RBBB) following heart transplantation (HT) and graft rejection. Materials and Methods We investigated 51 patients who underwent endomyocardial biopsies, electrocardiogram, right-side cardiac catheterization, and echocardiography at 1 month and 1 year after HT. We classified patients into four groups according to the development of RBBB, based on electrocardiogram at 1 month and 1 year: 1) sustained RBBB, 2) disappeared RBBB, 3) newly developed RBBB, and 4) sustained non-RBBB. The RBBB was defined as an RSR' pattern in V1 with a QRS duration ≥100 ms on electrocardiogram. Results The newly developed RBBB group (n=13, 25.5%) had a higher rate of new onset graft rejection (from grade 0 to grade ≥1R, 30.8% vs. 10.0% vs. 21.4%, p =0.042) at 1 year, compared with sustained RBBB (n=10, 19.6%) and sustained non-RBBB group (n=28, 54.9%). In contrast, the incidence of resolved graft rejection (from grade ≥1R to grade 0) was higher in the sustained RBBB group than the newly developed RBBB and sustained non-RBBB groups (70.0% vs. 7.7% vs. 25.0%, p =0.042). Left atrial volume index was significantly higher in the newly developed RBBB group than the sustained RBBB and sustained non-RBBB groups (60.6±25.9 mL/m 2 vs. 36.0±11.0 mL/m 2 vs. 38.4±18.1 mL/m 2 , p =0.003). Conclusion Close monitoring for new development of RBBB at 1 year after HT, which was associated with a higher incidence of new onset graft rejection, may be helpful to identify high risk patients for graft rejection.

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Paroxysmal atrioventricular block after heart transplantation in children: an early sign of rejection?

Cited by 5 publications

References 11 publications

Pediatric heart transplantation—What are the risk factors for pacemaker implantation and how much pacing is required?

Pediatric heart transplantation—What are the risk factors for pacemaker implantation and how much pacing is required?

Permanent pacemaker implantation in pediatric heart transplant recipients: A systematic review and evidence quality assessment

Association of Newly Developed Right Bundle Branch Block with Graft Rejection Following Heart Transplantation

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