Clinical Electrophysiology -> SCA Risk Assessment: -> Other Noninvasive Techniques D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-222 - Determinants Of Sudden Cardiac Death After Heart Transplantation (ID 502)

Abstract

Background: Heart transplant recipients are suspected to be at high-risk of sudden cardiac death (SCD). However, the risk stratification of SCD in this population is limited by the paucity of data.
Objective: To assess the predictors of SCD beyond the first-year post-transplant.
Methods: We enrolled 1,363 consecutive patients transplanted between 2004 and 2017 in two French centers. We excluded patients deceased during the first year. Patients underwent an evaluation at the day of transplantation and during the first year, comprising clinical, biological, histological, immunological (circulating anti-HLA DSA) and interventional (cardiac allograft vasculopathy) parameters. Echocardiographies were routinely performed in all included patients according to a prespecified protocol. SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms. Cox model analysis was used to determine the parameters associated with sudden death risk.
Results: A total of 913 patients were included. The median follow-up post-HT was 5.9 years (IQR=2.9-8.5). Among the 213 deaths beyond the first year, 44 patients (21%) died from SCD. In this population, the incidence rate of SCD was 0,82 per 100 person-year (95% CI: 0,51-2,05). Among the 60 parameters tested in univariate analysis, we identified 2 independent determinants of sudden death after 1 year post-HT : left ventricular ejection fraction (LVEF) ≤55% any time after transplantation (HR 4.07, 95% CI 1.94-8.53, p<0.001) and the presence of circulating anti-HLA DSA at the time of transplantation (HR 2.79, 95% CI 1.37-5.68, p=0.005). The incidence rate of SCD was 2.17 per 100 person-year (95% CI: 1.42;4.60) and 1.21 per 100 person-year (95% CI: 0.80; 2.58) in patients with FEVG<55% (n=73) and in patients with pre-formed DSA (n=260), respectively.
Conclusion: In a large multicentric and highly phenotyped cohort of heart transplant recipients, we identified two independent factors associated with SCD beyond the first year. This study provides fresh evidence of SCD assessment for improving risk stratification of HT recipients. The implantation of cardioverter-defibrillators in this high-risk population has to be discussed.
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