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Prognosis of patients paced for chronic atrioventricular block
Insights
Pacemaker use for chronic complete atrioventricular block showed increased mortality compared to the general population. Younger patients (50-59) experienced significantly higher mortality ratios, possibly due to underlying coronary artery disease.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Chronic complete atrioventricular block necessitates pacing for survival.
- Historical data on long-term outcomes for paced patients is crucial for understanding prognosis.
Purpose of the Study:
- To analyze the survival rates of patients paced for chronic complete atrioventricular block between 1960 and 1974.
- To identify factors influencing mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 839 patients paced for chronic complete atrioventricular block.
- Comparison of observed mortality with expected mortality based on general population data.
- Stratification of mortality by age, history of myocardial infarction, pacing characteristics, and QRS duration.
Main Results:
- Overall mortality was 1.7 times higher than expected in paced patients.
- Patients with a history of myocardial infarction had increased mortality.
- Mortality varied significantly by age group, with a 4.5:1 ratio in the 50-59 year olds, but similar survival to controls in the 80-89 year olds.
Conclusions:
- Pacemaker implantation for chronic complete atrioventricular block is associated with increased mortality.
- Age is a critical factor influencing survival outcomes in paced patients.
- Underlying coronary artery disease may contribute to higher mortality in younger paced individuals.
Abstract:
Between the years 1960 and 1974, 839 patients were paced for chronic complete atrioventricular block. Analysis of survival compared with the general population showed that 170 deaths were expected according to standard mortality tables and 288 actually occurred, giving a ratio of actual to expected deaths of 1.7:1. Patients with a definite history of myocardial infarction showed a higher than average mortality when paced. Mortality was not influenced whether heart was constant or intermittent, whether the ventricular rate was below or above 40/minutes, or whether QRS duration was greater or less than 0.1 second. Analysis of the age groups paced disclosed the most important correlations. Between the ages of 80 and 89 years paced patients could expect to survive as long as other of the same age without heart block. There was, however, a very high ratio of 4.5:1 for 90 patients in the age group 50 to 59 years. The reason for the high mortality ratio was uncertain but it may have been the result of a greater incidence of underlying coronary artery disease.