(1530) The Association of Temporary Pacemaker Settings on ICU Length of Stay After Heart Transplantation

Introduction: Bradycardia after heart transplantation is associated with significant morbidity and if sustained may warrant placement of a permanent pacemaker. As a result, it is common practice to place temporary epicardial pacing wires after transplantation to prevent postoperative bradycardia. However, there is currently no data to support selecting any one temporary pacing modality over another. In our study we investigated patients who underwent heart transplantation and had epicardial pacing wires placed to determine if the selected mode of pacing postoperatively was associated with prolonged ICU length of stay.

Methods: This was a single center retrospective cohort study of patients who underwent heart transplantation from 1/1/2019 to 12/31/2021. Patients were followed from the time of transplantation until their date of discharge from the intensive care unit (ICU). Prolonged ICU length of stay was defined as greater than 5 days. Baseline characteristics of patients were collected and multivariable logistic regression was performed to determine the odds ratio of prolonged ICU length of stay. Logistic regression was performed to determine the impact of different temporary pacing modality on length of stay. The Kruskal-Wallis test was also performed to determine if there were any differences between mean length of stay.

Results: There were a total of 124 patients included in this study. The average age was 59, and 87 (70%) were male. 76 (61%) were White, 42 (34%) were Black, and 2 (2%) were Asian. The majority of transplants were for nonischemic cardiomyopathies (68%). Baseline characteristics associated with a prolonged ICU length of stay were use of temporary mechanical circulatory support devices (MCS) prior to heart transplant (p-value = 0.01) and prior implantation of a pacemaker (p-value = 0.01). There was no association between postoperative temporary epicardial pacemaker modality and prolonged ICU length of stay (p-value = 0.76).

Conclusions: The settings of temporary epicardial pacemakers placed after heart transplant had no impact on ICU length of stay but prior use of an MCS device and prior permanent pacemaker implantation were associated with a prolonged ICU course.