Prognosis of super-elderly healthy Japanese patients after pacemaker implantation for bradycardia

Yamaguchi, Tetsuo; Miyamoto, Takamichi; Iwai, Takamasa; Yamaguchi, Junji; Hijikata, Sadahiro; Miyazaki, Ryoichi; Miwa, Naoyuki; Sekigawa, Masahiro; Hara, Nobuhiro; Nagata, Yasutoshi; Nozato, Toshihiro; Yamauchi, Yasuteru; Obayashi, Toru; Isobe, Mitsuaki

doi:10.1016/j.jjcc.2016.09.009

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Previous studies have also shown that mortality rate in patients over 85 years but with good functional status at the time of PPM implant is similar to that of younger patients. 26 Similarly, female gender was similar in both IP and OP groups and was not significant as a risk factor alone.…”

Section: Discussionmentioning

confidence: 89%

Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Sharp,

Matthews,

Papageorgiou

et al. 2023

Pacing Clinical Electrophis

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BackgroundPermanent pacemaker (PPM) implantation is a well‐established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns.MethodsMortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan‐Meier plots and compared using the log‐rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30‐day and 1‐year all‐cause mortality of inpatient implant.ResultsOf the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log‐Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1‐year all‐cause mortality (HR 3.40, 95% CI 1.97–5.86, p < 0.001) on multivariable analysis.ConclusionsSND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.

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Section: Discussionmentioning

confidence: 89%

Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Sharp,

Matthews,

Papageorgiou

et al. 2023

Pacing Clinical Electrophis

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Survival of patients after pacemaker implantation was addressed only by a few studies, mostly evaluating differences between different modes of pacing; 9 data regarding survival in pacemaker recipients are lacking, not only in elderly patients. 7,[10][11][12] Randomized studies in patients with clear indications for pacemaker implantation are not feasible; therefore, achieving the precise impact of such treatment is difficult. Nevertheless, in some patients with a short life expectancy, the choice between good clinical practice and therapeutic persistence can be very difficult.…”

Section: Survival After Pacemaker Implantationmentioning

confidence: 99%

Short- and long-term survival in patients over 90 years old undergoing pacemaker implantation

Zecchin,

Trevisan,

Baggio

et al. 2023

Journal of Cardiovascular Medicine

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Aims In Italy, 12-month survival in the general population between 90 and 94 years old is 26%. In very old patients, the benefit of pacemaker implantation in terms of quality and duration of life is unclear. The aim of our study was to analyse clinical characteristics, outcome and factors associated with survival in patients at least 90 years old at the time of the first pacemaker implant. Methods Clinical parameters, device characteristics, survival and predictors of outcome in patients at least 90 years old treated with a pacemaker in our centre in 2019–2020 were evaluated. Results Among the 554 patients undergoing pacemaker implantation in our centre during the study interval, 69 (12%) were at least 90 years old; a complete/advanced atrioventricular block was present in 65%. A cardiological comorbidity (excluding atrial fibrillation) was present in 22 patients (32%). Oncological, pulmonary and neurological comorbidities were present in 12 (17%), 19 (28%) and 32 (46%), respectively. Renal impairment was present in 25 patients (36%). After pacemaker implantation, a pneumothorax developed in two patients and lead dislodgment in one. During follow-up (median 17 months, interquartile range: 13–24), 32 patients died (46%), with a 12-month mortality probability of 24.6%. At multivariate analysis, the presence of oncological (hazard ratio (HR) 5.31; P < 0.001) and neurological (HR 6.44; P < 0.001) comorbidities was associated with mortality. Truncating the outcome at 6 months, renal impairment (HR 8.01; P = 0.003), anticoagulant therapy (HR 8.14; P = 0.003), oncological comorbidities (HR 14.1; P < 0.001) and left ventricular function (5% increase of left ventricular ejection fraction: HR 0.66; P < 0.001) were significantly associated with outcome. Conclusion At our centre, patients at least 90 years old underwent pacemaker implantation mainly for advanced atrioventricular block. One-year survival was excellent, even better than expected in the general population.

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“…The rationale for the alternative pacing site is that maintaining AV synchrony could prevent ventricular dyssynchronization. However, there have been data that have shown that a wide QRS duration was associated with poor outcomes also in patients with an implanted pacemaker with a lead in the RV outflow tract [20], and the mortality rate was similar in RV apical pacing and septal pacing [21]. In our study, about 80% of patients with a paced QRS duration of less than 160 ms and an axis of less than À708, had no adverse events over the long-term follow-up.…”

Section: Placement Of the Rv Leadmentioning

confidence: 99%

Predictors of an adverse clinical outcome in patients with long-term right ventricular apical pacing

Sohn

Lee

Park

et al. 2017

Journal of Cardiology

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Prognosis of super-elderly healthy Japanese patients after pacemaker implantation for bradycardia

Cited by 9 publications

References 11 publications

Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Short- and long-term survival in patients over 90 years old undergoing pacemaker implantation

Predictors of an adverse clinical outcome in patients with long-term right ventricular apical pacing

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