title: Pacemaker implantation in pediatric heart transplant recipients: Predictors, outcomes, and impact on survival.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Iqbal
authors.initials: I
authors.lastname: El-Assaad
authors.affiliation: Advanced Heart Failure Center, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sadeer G
authors.initials: SG
authors.lastname: Al-Kindi
authors.affiliation: Advanced Heart Failure Center, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio.
authors.forename: Penny
authors.initials: P
authors.lastname: Houghtaling
authors.affiliation: Department of Cardiovascular Medicine, Section of Cardiac Pacemakers and Electrophysiology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.affiliation: Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Boyle
authors.affiliation: Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. Electronic address: azizp@ccf.org.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Aziz
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003956:Dialysis / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival; D006325:Heart Atria / Q000002:abnormalities; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Bradyarrhythmia; Heart transplantation; Pacemaker; Pediatric population; United Network for Organ Sharing database