Parameters associated with one-year mortality and in-hospital adverse events in patients after emergency pacemaker...

Permanent cardiac pacing is the treatment of choice for severe and symptomatic bradycardia. Patients undergoing emergency pacemaker implantation are stabilised earlier by the insertion of a temporary emergency pacing lead, and they experience more comorbidities than with planned admissions.

To identify the parameters associated with one-year mortality and in-hospital adverse events after emergency permanent pacemaker implantation.

This retrospective study analyses data from 131 consecutive emergency pacemaker implantations performed within a single centre.

Cox regression analysis revealed the independent predictors of death to be: use of a temporary transvenous pacing lead (TTPL) (HR = 2.82, 95% CI 1.21-6.58, p = 0.02), age ≥ 78 years (OR = 3.01, 95% CI 1.22-7.42, p = 0.02), longer baseline QRS duration (HR = 1.02, 95% CI 1.00-1.03, p = 0.03), and history of myocardial infarction (MI) (HR = 2.43, 95% CI 1.04-5.68, p = 0.04). Twenty-six patients experienced in-hospital adverse events, such as: death (n = 6), cardiac arrest (n = 3), surgical complications (lead dislocation: n = 4, haematoma: n = 4, microperforation: n = 2), pneumonia or respiratory tract disease (n = 7), wound infection treated with antibiotics (n = 1), and subsequent MI following pacemaker implantation (n = 2). Multivariate logistic regression analysis showed that independent parameters associated with in-hospital adverse events were history of MI (OR = 5.01, 95% CI 1.88-13.3, p = 0.001) and stroke (OR = 3.51, 95% CI 1.16-10.55, p = 0.03).

Our results suggest that the most serious risk factors of one-year mortality related to the use of TTPL are: age ≥ 78 years, longer baseline QRS duration, and history of MI. The independent parameters associated with in-hospital adverse events were the presence of a history of MI and stroke.