Background: The rate of pacemaker (PM) implantations is constantly growing. Since life expectancy of the population is projected to increase, a large number of nonagenarian patients will need PM implantation. We aimed at analyzing short-and long-term outcomes after PM implantation in nonagenarians.Methods: Patients aged ≥90 years referred for PM implantation from 2004 to 2017 were included. The primary clinical endpoint was total mortality. Secondary endpoints included procedure-related and in-hospital complications.Results: A total of 172 patients were included (92.6 AE 2.1 years, from 90.0 to 101.4 years). Procedure duration was 50.0 AE 19.7 minutes. Most of the patients had VVI devices implanted (143 pts, 83.1%) and mean hospital stay was 3.5 AE 1.5 days. Nine patients (5.2%) had shortterm device-related complications and 29 patients (16.8%) had post-procedural complications, non-related to the implantation, including four leading to patients' death. During a follow-up of 22.5 months (interquartile range: 7.3-38.0), 94 patients (54.7%) died. Survival rates were 82.9% (95% confidence interval [CI]: 76.0-88.0), 73.7% (95% CI: 65.7-80.1) and 37.5% (95% CI: 27.5-47.5) after 1, 2, and 5 years, respectively. The Charlson comorbidity index was a predictive factor of procedural complications (odds ratio = 1.33; 95% CI: 1.05-1.69, P = 0.02) while having a complication (hazard ratio [HR] = 4.04; 95% CI: 1.79-9.11, P = 0.001) and atrial fibrillation (HR = 1.63; 95% CI: [1.02-2.63], P = 0.043) were predictors of post-implantation death. Conclusion: PM implantation in nonagenarians is safe, with a low risk of procedural complications, but many comorbidities-related complications can occur. Caution should be taken in this old and frail population since complications significantly impact patients' survival. K E Y W O R D S complications, nonagenarian, pacemaker about 10 years. By 2060, life expectancy is projected to be 89.1 and 84.6 years for female and male, respectively, and the number of patients aged 80 and more is expected to be double. Currently, only few studies specifically reported the long-term outcome of PM implantation in elderly patients. Mandawat et al. evaluated the shortterm mortality and complications of PM implantation in elderly patients, reporting 1.87% and 6.31% mortality and complications rates in nonagenarians, respectively. 4 Also, Udo et al. studied outcome of PM recipients aged >80 and reported a cumulative 5-year survival of around 50% after implantation, with an 18.1% complication rate. 5More recently, Loirat et al. described short-and long-term outcomes of PM replacement in nonagenarians, reporting AF and nonphysiological pacing as predictors of mortality. 6 However, no studies specifically evaluated the short-and long-term outcomes of PM primo-implantation in nonagenarian. Therefore, in the present study, we aimed at analyzing the procedural characteristics, survival rate, and causes of deaths in nonagenarians.
| METHODS
| Study population and data collectionConsecutive patients aged >90 years ...