PO-05-024 LEADLESS CARDIAC PACEMAKER IMPLANTATION IN HEART TRANSPLANT RECIPIENTS: SAFETY AND OUTCOMES

Abstract

Leadless cardiac pacemakers (LCP) appear to have lower risk of device infection and bacteremia compared to transvenous systems. Heart transplant patients are at increased risk for cardiovascular implantable electronic device complications, but there is limited data on the safety and effectiveness of LCPs in these patients; this is especially true when repeat myocardial biopsies are necessary. To report outcomes and device performance of LCPs in heart transplant recipients, some of whom also underwent endomyocardial biopsies Retrospective analysis of all heart transplant recipients at a single institution who received a leadless pacemaker, either tine-affixed (Micra – Medtronic Inc.) or helix- affixed (Aveir – Abbott Inc.), between April 2018 thru September 2022. Data on demographics, clinical characteristics, pacemaker interrogations, device changes, endomyocardial biopsies, and cardiac allograft vasculopathy screening was collected. Pacemaker interrogations were performed and data collected as the patients were followed. Twelve heart transplant patients underwent LCP implantation (tine-affixed: 11 patients; helix-affixed: 1 patient): mean age was 59.5±12.5 years, gender 8 males/4 females. The indication for LCP implantation was sinus node disease (n=2) or high-degree AV block (n=10). The mean follow-up time was 473±518 days. A total of 12 endomyocardial (mean 1±1.3) biopsies were performed in 6 patients (see Swimmer plot figure). Pacemaker interrogation showed no clinically significant differences in pacing thresholds, sensing or impedance over time, and following biopsies. Two patients underwent upgrade to CRT-P during follow-up. Leadless cardiac pacemakers are a viable treatment option for symptomatic bradycardia in patients after heart transplant. Endomyocardial biopsies do not appear to affect LCP function. Further research is needed to confirm the safety and efficacy of leadless pacemakers in patients with history of heart transplantation.