Risk factors and survival of patients with permanent pacemaker implantation after heart transplantation

Rivinius, Rasmus; Helmschrott, Matthias; Rahm, Ann‐Kathrin; Darche, Fabrice F.; Thomas, Dierk; Bruckner, Tom; Doesch, Andreas O.; Ehlermann, Philipp; Katus, Hugo A.; Zitron, Edgar

doi:10.21037/jtd.2019.11.45

Cited by 21 publications

(98 citation statements)

References 42 publications

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“…Kaplan–Meier estimator was employed to graphically display 1 year post‐transplant survival. A P ‐value of <0.05 was considered statistically significant 3,4,19–23 …”

Section: Methodsmentioning

confidence: 99%

“…Patients were seen monthly during the first 6 months after HTX, then bimonthly until the end of the first year, and thereafter usually three to four times per year (or if clinically indicated). Routine follow‐up included medical history, physical examination, 12‐lead electrocardiogram, echocardiography, and routine laboratory analysis including immunosuppressive drug monitoring 3,4,19–23 …”

Section: Methodsmentioning

confidence: 99%

“…From 2001 onward, azathioprine was subsequently substituted by mycophenolate mofetil, and cyclosporine A was consecutively replaced by tacrolimus from 2006 onward. Steroids (prednisolone) were tapered incrementally during the first post‐transplant months and were finally discontinued 6 months after HTX (if clinically possible) 3,4,19–23 …”

Section: Methodsmentioning

confidence: 99%

“…Additionally, our study had a total of 600 patients, which is comparable in size with multicentre studies. 3,4,[19][20][21][22][23] This analysis included patients receiving HTX at Heidelberg Heart Center between 1989 and 2016. Due to this long study period, a possible era effect resulting from changes in medical care may have affected post-transplant outcomes.…”

Section: Study Limitationsmentioning

confidence: 99%

“…This analysis revealed comparable results. 3,4,[19][20][21][22][23] Serum levels of digoxin or digitoxin directly before HTX were not available. A potential association between increased post-transplant mortality and higher serum levels of digitalis could therefore not be analysed.…”

Section: Study Limitationsmentioning

confidence: 99%

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Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

et al. 2020

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Aims Amiodarone and digitalis are frequently used drugs in patients with heart failure. Both have separately been linked to reduced post-transplant survival, but their combined impact on mortality after HTX remains uncertain. This study investigated the effects of combined amiodarone and digitalis use before HTX on post-transplant outcomes. Methods and results This registry study analysed 600 patients receiving HTX at Heidelberg Heart Center between 1989 and 2016. Patients were stratified by amiodarone and digitalis use before HTX. Analysis included patient characteristics, medication, echocardiographic features, heart rates, permanent pacemaker implantation, atrial fibrillation, and post-transplant survival including causes of death. One hundred eighteen patients received amiodarone before HTX (19.7%), hereof 67 patients with digitalis (56.8%) and 51 patients without digitalis before HTX (43.2%). Patients with and without amiodarone before HTX showed a similar 1 year post-transplant survival (72.0% vs. 78.4%, P = 0.11), but patients with combined amiodarone and digitalis before HTX had a worse 1 year post-transplant survival (64.2%, P = 0.01), along with a higher percentage of death due to transplant failure (P = 0.03). Echocardiographic analysis of these patients showed a higher percentage of an enlarged right ventricle (P = 0.02), left atrium (P = 0.02), left ventricle (P = 0.03), and a higher rate of reduced left ventricular ejection fraction (P = 0.03). Multivariate analysis indicated combined amiodarone and digitalis use before HTX as a significant risk factor for 1 year mortality after HTX (hazard ratio: 1.69; 95% confidence interval: 1.02-2.77; P = 0.04). Conclusions Combined pre-transplant amiodarone and digitalis therapy is associated with increased post-transplant mortality.

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“…Kaplan–Meier estimator was employed to graphically display 1 year post‐transplant survival. A P ‐value of <0.05 was considered statistically significant 3,4,19–23 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

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Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

et al. 2020

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Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival

et al. 2021

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Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post-transplant survival remains uncertain. This study investigated the post-transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty-nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre-existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1-year post-transplant survival (36.1%, P < 0.01) compared with patients with pre-existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1-year mortality after HTX (HR: 2.20; 95% CI: 1.68-2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30-day atrial fibrillation (P < 0.01) and 1-year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post-transplant mortality.

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Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

et al. 2021

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Aims Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. Methods and resultsThis study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. Conclusions Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.

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Risk factors and survival of patients with permanent pacemaker implantation after heart transplantation

Cited by 21 publications

References 42 publications

Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival

Atrial fibrillation before heart transplantation is a risk factor for post‐transplant atrial fibrillation and mortality

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