Pacemaker implantation in pediatric heart transplant recipients: Predictors, outcomes, and impact on survival

Background Little is known about the incidence of permanent pacemaker (PPM) implantation after heart transplantation (HTx) in the pediatric population. Objective The purpose of this study was to investigate the incidence, predictors, and outcomes of acute need for PPM implantation in pediatric HTx recipients. Methods We queried the United Network for Organ Sharing (UNOS) database for all pediatric (age <18 years) patients who received HTx (1994-2014). Regression models are reported for prediction of PPM implantation. Results A total of 6156 patients were analyzed, of whom 69 (1.1%) required posttransplant PPM implantation acutely. PPM use decreased over the study period (hazard ratio [HR] 0.95, P =.01). Compared with the non-PPM group, PPM group was more likely to be older (10 vs 5.0 years, P <.001), used antiarrhythmics (35.6% vs 18.3%, P =.006), required intraaortic balloon pump (2.9% vs 0.5%, P =.049), and had undergone biatrial anastomosis (68.1% vs 48.2%, P =.007). In a multivariable model, PPM implantation was predicted by higher donor age (HR 1.05, P =.002), biatrial anastomosis (HR 2.53, P =.04) and antiarrhythmic use (HR 2.12, P =.02). After adjusting for baseline characteristics, PPM recipients were at increased risk for posttransplant infection (47.8% vs 26.4%, P =.001) and dialysis (15.9% vs 6.6%, P =.003). Adjusted graft survival did not differ between the 2 groups (P =.78). Conclusion Acute postoperative PPM implantation in pediatric HTx recipients is rare and has decreased over time. Acute PPM use is associated with biatrial anastomosis, antiarrhythmic use, and older donor age. Although PPM recipients had higher incidences of infections and dialysis, PPM implantation did not adversely impact survival.