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The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients recommend the placement of temporary epicardial pacing wires at the time of surgery. However, there is little data regarding optimal postoperative pacing modality and its implications on intensive care unit (ICU) length of stay (LOS).We conducted a single-center retrospective cohort study of 187 patients who underwent heart transplantation from January 1, 2019 to February 28, 2023 and had postoperative epicardial pacemaker wires placed. The study's primary outcome was to observe the association between pacing modalities and prolonged ICU LOS (greater than 5 days). The secondary outcome was to observe the association between pacing modalities and prolonged hospital LOS (greater than 15 days), readmission within 30 days of discharge, days on inotropic and pressor support, death, high-grade rejection on biopsy, coronary artery vasculopathy at 1 year, primary graft dysfunction, mediastinitis, and development of a malignancy.Twenty-two patients (12%) had their pacing mode turned off at the time of arrival to the ICU, 36 patients (19%) had their pacing mode set to atrially paced, atrially sensed, inhibit, 101 patients (54%) had theirs set to dual chamber paced, dual chamber sensed, triger/inhibit sensed events, and 28 (15%) had theirs set to ventricularly paced, ventricularly sensed, inhibit. No mode of epicardial pacing was associated with an increased ICU LOS, hospital LOS, increased readmission rates, increased short-term adverse effects, increased long-term adverse effects, or increased duration of support with vasoactive medications.Our study demonstrated no significant association between the mode of temporary pacing and LOS or adverse effects after heart transplantation.

Objective: To assess the effect of coronavirus disease 2019 (COVID-19) infection on heart transplant recipients requiring immunotherapy. To investigate the effectiveness of vaccination in immunosuppressed heart transplant recipients during the initial years of the COVID-19 pandemic, and to examine the timing of COVID-19 infections in heart transplant recipients’ posttransplantation. Patients and Methods: International data on COVID-19 infection in immunosuppressed populations is limited. Heart transplant recipients requiring immunotherapy are at risk for increased complications with COVID-19 infection. The availability of vaccination and temporal trends in this population has not been well described. We report outcomes in immunosuppressed patients during the initial years of the COVID-19 pandemic from March 1, 2019, to October 31, 2021, at Mayo Clinic in Florida. Results: A total of 98 patients were reviewed, of which 49 were COVID-19–positive (CP), and 49 were negative (CN). The cohort was well matched, with a median age of 58 years (49–65 years) in both groups. Females consisted of 41% in the CP group and 18.4% in the CN group. Immunosuppression was not significantly different for CP or CN patients. The median time from transplant to CP was 384 days (237–677 days). The CN group’s median follow-up after transplant was 947 days (737–1191 days). The CP hospitalization rate was 24% with only 1 death. More CP patients were vaccinated than the CN group (92% vs 78%, P=.025). Conclusion: Our study sheds light on COVID-19’s effect on heart transplant recipients and vaccination in this population. Our findings suggest a potentially heightened infection risk within the first 1.5 years posttransplant, highlighting the need to optimize management strategies and vaccine efficacy in this vulnerable group.

We present a case of a 45-year-old female with advanced heart failure due to nonischemic cardiomyopathy, an ejection fraction of 15% complicated by ventricular arrhythmias degenerating into an electrical storm. The treatment approach involved antiarrhythmic medications, inotrope support, diuretics, and the placement of an Impella 5.5 device for mechanical circulatory support. Due to persistent polymorphic ventricular tachycardia, a bilateral stellate ganglion blockade was performed along with intensified antiarrhythmic therapy and deep sedation. This case highlights the role of axillary mechanical circulatory support with the Impella 5.5 in providing unfettered hemodynamic stability and the potential added benefit of stellate ganglion blockade in managing malignant ventricular arrhythmias.

In this paper, we present a detailed case study from our transplant evaluation clinic, focusing on a postpartum patient with end-stage heart and kidney failure being considered for heart transplantation. The evaluation revealed pituitary dysfunction, correlating with Sheehan syndrome, a condition arising from significant blood loss that leads to pituitary gland hypoperfusion and necrosis. This diagnosis is particularly noteworthy considering the pituitary gland's vital role in hormonal regulation, which impacts multiple organ systems. The gland's vulnerability to ischemia, especially due to its enlargement during pregnancy, is a critical factor. Our case highlights the necessity of thorough pretransplant evaluations to identify reversible endocrine factors contributing to organ failure, emphasizing the complex interplay between endocrine health and organ transplant suitability. This study serves as an important reminder for clinicians to consider endocrine causes in transplant candidates, especially in postpartum patients.