Implantation of a permanent pacemaker following orthotopic heart transplantation: a systematic review and meta-analysis.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-08-27 DOI:10.1007/s10840-024-01909-5

Patavee Pajareya, Sathapana Srisomwong, Noppachai Siranart, Ponthakorn Kaewkanha, Yanisa Chumpangern, Narut Prasitlumkum, Jakrin Kewchareon, Ronpichai Chokesuwattanaskul, Nithi Tokavanich

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引用次数: 0

Abstract

Background: Orthotopic heart transplant (OHT) is among the final armamentariums for end-stage heart disease. Many patients who have had OHT require a post-transplant permanent pacemaker (PPM) implantation due to an abnormal conduction system. We aimed to evaluate the risk of mortality and acute rejection in patients with OHT who had received PPM compared to patients without PPM and to determine predictors for PPM placement in this population.

Methods: We comprehensively searched for studies from MEDLINE, EMBASE, and Cochrane databases from inception to September 2023. Inclusion criteria focused on patients who had undergone OHT and PPM implantation post-transplant. Data from each study were combined using a random-effects model. Results were expressed as relative risk (RR) or odd ratios (OR) with a 95% confidence interval (CI).

Results: A total of 9 studies were included in this meta-analysis incorporating a total of 54,848 patients (3.3% had PPM). The pooled all-cause mortality rate among patients with PPM post-OHT was 26% (95% CI: 19-33%, I² = 1%). There were no differences between post-heart transplant patients with PPM and those without PPM in risk of all-cause mortality (RR 0.76, 95% CI: 0.43-1.34; I² = 45%) and acute rejection (RR 1.22, 95% CI: 0.74-2.00, I² = 59%). Bi-atrial anastomosis was associated with an increased risk of PPM implantation post-OHT (OR 7.74, 95% CI: 3.55-16.91, I² = 0%), while pre-OHT mechanical circulatory support (MCS) was associated with a decreased risk of PPM implantation post-OHT (OR 0.45, 95% CI 0.27-0.76, I² = 0%).

Conclusion: There were no significant differences in all-cause mortality or acute rejection between post-OHT recipients who required PPM compared to those who did not receive PPM. Further, bi-atrial anastomosis portended the need for PPM implantation, while MCS was associated with a decreased occurrence of PPM.

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矫形心脏移植后永久起搏器的植入：系统综述和荟萃分析。

背景：异位心脏移植（OHT）是治疗终末期心脏病的最后手段之一。许多 OHT 患者由于传导系统异常，需要在移植后植入永久起搏器（PPM）。我们的目的是评估与未接受过永久起搏器植入术的患者相比，接受过永久起搏器植入术的 OHT 患者的死亡率和急性排斥反应风险，并确定在这一人群中植入永久起搏器的预测因素：我们在 MEDLINE、EMBASE 和 Cochrane 数据库中全面检索了从开始到 2023 年 9 月的研究。纳入标准主要集中在移植后接受过 OHT 和 PPM 植入术的患者。采用随机效应模型对每项研究的数据进行合并。结果以相对风险（RR）或奇数比（OR）及95%置信区间（CI）表示：本荟萃分析共纳入了 9 项研究，共计 54,848 名患者（3.3% 患有 PPM）。OHT术后PPM患者的全因死亡率合计为26%（95% CI：19-33%，I2 = 1%）。在全因死亡率（RR 0.76，95% CI：0.43-1.34；I2 = 45%）和急性排斥反应（RR 1.22，95% CI：0.74-2.00，I2 = 59%）风险方面，有 PPM 和没有 PPM 的心脏移植术后患者之间没有差异。双心房吻合术与OHT后PPM植入风险增加有关（OR 7.74，95% CI：3.55-16.91，I2 = 0%），而OHT前机械循环支持（MCS）与OHT后PPM植入风险降低有关（OR 0.45，95% CI 0.27-0.76，I2 = 0%）：结论：OHT术后需要植入PPM的受术者与未植入PPM的受术者在全因死亡率或急性排斥反应方面没有明显差异。此外，双心房吻合术预示着需要植入PPM，而MCS与PPM发生率降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.