Sudden Cardiac Arrest After Pediatric Heart Transplantation

Abstract

<h3>Purpose</h3> Sudden cardiac arrest (SCA) is a prevailing cause of mortality after pediatric heart transplant (HT) but remains understudied. The purpose of this study was to analyze the incidence, outcomes and risk factors for SCA at our center. <h3>Methods</h3> Retrospective review of all pediatric HT patients at our center from 1/1/2009-9/1/2021. SCA was defined as an abrupt loss of cardiac function requiring cardiopulmonary resuscitation and/or mechanical circulatory support (MCS). Events that occurred in the first post-operative week, while on MCS, or in the setting of limited resuscitative wishes were excluded. Patient characteristics and risk factors were analyzed. <h3>Results</h3> Of 254 transplants during the study period, 16 (6%) experienced SCA at a median of 2 (1, 4) years post-HT. Thirteen (81%) died from their initial event, 4 of those (31%) after placement on MCS. SCA accounted for 30% of the 46 deaths during this time period. Seven (44%) events occurred at home. In univariate analysis, black race, internal cardiac defibrillator, history of post-HT extracorporeal membrane oxygenation (ECMO), prior cellular rejection (ACR) episode, retransplantation, and diagnosis of allograft vasculopathy (CAV) were associated with SCA (<i>P</i> =0.02-0.001, Table 1). In multivariable analysis, history of post-HT ECMO retained significance. [OR 14.5, 95% CI: 3.4-62.5, <i>P</i><0.001] <h3>Conclusion</h3> SCA occurs relatively early after pediatric HT and is often fatal. Nearly half of events happen at home. Patients with a history of ACR, CAV, retransplant, and prior history of ECMO are at increased risk. Multicenter investigation is needed to better understand SCA, reduce occurrence and improve outcomes.