Sinus node dysfunction after heart transplantation—An analysis of risk factors and atrial pacing burden

Herrmann, Florian Ernst Martin; Wellmann, Petra; Sadoni, Sebastian; Schramm, René; Hagl, Christian; Juchem, Gerd

doi:10.1111/ctr.13202

Cited by 14 publications

(9 citation statements)

References 20 publications

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“…Prolonged ischemic time has previously been reported to be associated with bradyarrhythmias after HTX as hypoxia during surgery can cause damage to the sinus node and the electrical conduction system of the cardiac allograft (1,4,28). However, we and other recent studies could not detect a significant association between ischemic time and PPM implantation after HTX (5,7,(11)(12)(13).…”

Section: Risk Factors For Ppm Implantation After Htxcontrasting

confidence: 93%

“…Due to the lack of organ donation, it is essential to continuously improve quality of life and to search for risk factors which may impair survival after HTX (11).…”

Section: Post-transplant Survival and Causes Of Deathmentioning

confidence: 99%

“…Regarding the analysis of further risk factors, complications, and long-term outcomes of PPM implantation after HTX, there is only a minority of studies with a population of more than 500 patients and only one multi-center study investigating the need for PPM implantation after HTX (3)(4)(5)(11)(12)(13)(14)(15). Additionally, studies yielded inconsistent results due to considerably differences in design, analyzed parameters, and length of followup.…”

Section: Introductionmentioning

confidence: 99%

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

Rivinius¹,

Helmschrott²,

Rahm³

et al. 2019

J Thorac Dis

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Background: Permanent pacemaker (PPM) implantation after heart transplantation (HTX) may be required due to severe bradycardia. The aim of this study was to investigate the risk factors, indications, perioperative outcomes and complications of PPM implantation after HTX as well as the underlying effect on post-transplant mortality including causes of death. Methods: This registry study included 621 patients receiving HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by PPM implantation after HTX. Data analysis of risk factors for PPM implantation included donor and recipient demographics, post-transplant medication, mortality, and causes of death. Results: Thirty-six patients (5.8%) received PPM implantation after HTX, 12 (33.3%) with early PPM and 24 (66.7%) with late PPM. Indications for PPM implantation after HTX included sinus node dysfunction (SND) (n=15; 41.7%) and atrioventricular block (AVB) (n=21; 58.3%). Multivariate analysis revealed recipient body mass index (BMI) [

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Section: Risk Factors For Ppm Implantation After Htxcontrasting

confidence: 93%

“…Due to the lack of organ donation, it is essential to continuously improve quality of life and to search for risk factors which may impair survival after HTX (11).…”

Section: Post-transplant Survival and Causes Of Deathmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Rivinius¹,

Helmschrott²,

Rahm³

et al. 2019

J Thorac Dis

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show abstract

“…While the effect of amiodarone on heart rate cannot be excluded, the difference in HR between the groups remained significant after adjustment for amiodarone treatment in multivariate analysis. Sinus node dysfunction is a common complication in the early post‐HTx setting, sometimes requiring permanent pacemaker placement, and has been linked to ischemia‐reperfusion injury . Some studies suggest alcohol increases donor heart susceptibility to this type of injury .…”

Section: Discussionmentioning

confidence: 99%

The effect of donor alcohol abuse on outcomes following heart transplantation

Newman

Liebo

Lowes

et al. 2019

Clinical Transplantation

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Background: Current guidelines recommend against the use of hearts from donors that abuse alcohol. We explored the effect of donor alcohol abuse (AA) on cardiac allograft function and outcomes in heart transplant (HTx) recipients. Methods:Overall, 370 HTx recipients were divided into two groups: (a) the alcoholic donor group (AD, n = 58) and (b) the non-alcoholic donor group (NAD, n = 312). Results:Recipients in the AD group had a slower heart rate (86 ± 13 vs 93 ± 13, P = 0.004) and an increased incidence of early atrial fibrillation (AF) (30% vs 11%, P = 0.003). Echocardiographic left ventricular mass was higher among alcoholic donors (171.7 ± 66.7 vs 151.6 ± 54.7, P = 0.02). This difference remained present 1 year following HTx (185 ± 43 vs 166 ± 42, P = 0.007). E/E′ was higher in the AD group (9.5 ± 3.9 vs 8.4 ± 2.9, P = 0.04) and a larger number of AD recipients had a ventilatory equivalent for VCO 2 > 34 (50% vs 31%, P = 0.04) on cardiopulmonary exercise test. There was no significant difference in rejection, cardiac allograft vasculopathy (CAV), or survival between the groups. Conclusions:Our data suggest that donor AA does not impact rejection, CAV, or intermediate-term survival, but may cause increased incidence of post-HTx AF and impaired cardiac allograft diastolic function. K E Y W O R D Satrial fibrillation, diastolic dysfunction, donor characteristics, heart transplantation

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“…In 2015, the Food and Drug Administration issued a warning against the concomitant use of amiodarone and sofosbuvir‐containing DAA regimens 20 . Despite being supported primarily by case reports and further limited by concomitant beta‐blocker use, these reports are concerning due to the risk for sinus node dysfunction post–heart transplant 20,21 . A prior study reported the safe use of sofosbuvir‐velpatasvir and concomitant amiodarone in 3 HCV NAT+ heart transplant recipients, although there were no details on the duration of treatment overlap and the degree of monitoring during therapy 9 .…”

Section: Discussionmentioning

confidence: 99%

Management and tolerability of glecaprevir‐pibrentasvir pharmacotherapy in hepatitis C viremic heart and lung transplant recipients

Lewis

Gidea

Reyentovich

et al. 2020

Clinical Transplantation

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We conducted a retrospective review of thoracic transplant recipients (22 heart and 16 lung transplant recipients) prospectively enrolled in a single‐center observational study of HCV NAT+ organ transplantation in HCV NAT− recipients. All recipients were treated with 8 weeks of glecaprevir‐pibrentasvir (GP) for HCV viremia in addition to standard triple immunosuppression post‐transplant. Thoracic transplant recipients of HCV NAT− organs were used as a control (24 heart and 22 lung transplant recipients). Our primary outcome was to assess the effect of GP on tacrolimus dose requirements. Secondary objectives included assessing drug interactions with common post‐transplant medications, adverse effects, and the need to hold or discontinue GP therapy. The median tacrolimus concentration‐to‐dose ratio (CDR) in the cohort was 184 (99‐260) during GP therapy and 154 (78‐304) over the first month after GP (P = .79). Trends in median tacrolimus CDR were similar on a per‐week basis and per‐patient basis. In three instances, concomitant posaconazole and GP led to hyperbilirubinemia and interruption of posaconazole. GP therapy was held in one heart transplant recipient and discontinued in another due to unresolving hyperbilirubinemia. Utilization of GP to treat HCV viremia post–thoracic transplant is feasible and safe, but requires modifications to post‐transplant pharmacotherapy and careful monitoring for adverse effects.

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Sinus node dysfunction after heart transplantation—An analysis of risk factors and atrial pacing burden

Abstract: We identified the biatrial anastomosis and a low ratio of reperfusion time to aortic cross-clamp time as well as to ischemia time as risk factors for SND requiring pacing. After implantation pacemakers continue to pace for over 60% of the time after 6 years.

Cited by 14 publications

References 20 publications

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

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

The effect of donor alcohol abuse on outcomes following heart transplantation

Management and tolerability of glecaprevir‐pibrentasvir pharmacotherapy in hepatitis C viremic heart and lung transplant recipients

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