Long-term survival after pacemaker implantation. Prognostic importance of gender and baseline patient characteristics

Permanent cardiac pacing is the treatment of choice in severe and symptomatic bradycardia. To determine factors associated with longer survival we analysed the survival times and baseline characteristics of 6505 patients after pacemaker implantation. This longitudinal study with 30 years of follow-up was performed in a single centre university hospital with all-cause mortality as the end-point. In 6505 patients we analysed a total of 30948 years of patient follow-up, median survival was 101.9 months ( approximately 8.5 years), with 44.8% of patients alive after 10 years and 21.4% alive after 20 years. In all subgroups women had a significantly longer survival than men (118 vs 91.7 months, P<0.0001), despite a markedly higher age at implantation (73.2 years vs 71 years, P<0.0001). Survival of patients with sick-sinus-syndrome was significantly better than in patients with high degree AV-block, which in turn, was better than survival of patients with atrial fibrillation (132.9 months vs 94.2 months vs 85.1 months, P<0.0001). Multivariate analysis revealed several independent factors: age, gender, decade of implantation, type of pacemaker, index arrhythmia and initial symptoms. Interestingly, if only the patients of the last decade were analysed multivariately, neither pacing mode nor index arrhythmia were independently associated with survival. In conclusion, survival of patients with pacemakers is independently influenced by several baseline characteristics which can identify patients with very long survival.