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Long-term survival after pacemaker implantation for heart block in patients > or = 65 years
W K Shen1, S C Hammill, D L Hayes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Permanent pacemaker implantation improves survival for elderly patients with high-degree atrioventricular block. However, survival remains lower for those with coexisting heart disease or advanced age.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Symptomatic high-degree atrioventricular (AV) block in elderly patients often necessitates permanent pacing.
- Long-term survival post-pacemaker implantation compared to general populations requires further definition.
Purpose of the Study:
- To assess long-term survival and identify mortality predictors in elderly patients receiving permanent pacemakers for symptomatic high-degree AV block.
- To compare survival rates with age- and sex-matched control groups.
Main Methods:
- Retrospective cohort study of Olmsted County residents aged 65+ undergoing permanent pacemaker implantation for high-degree AV block.
- Analysis of survival data over a mean follow-up of 4.2 years, stratified by isolated AV block versus coexisting heart disease.
Main Results:
- Observed survival rates at 1, 3, 5, and 10 years differed significantly between isolated AV block and coexisting heart disease groups.
- Patients aged 80+ with isolated AV block had reduced survival compared to controls; those with coexisting heart disease had significantly reduced survival regardless of age.
- Independent predictors of mortality included congestive heart failure, COPD, older age, syncope, diabetes, and male gender.
Conclusions:
- Permanent pacing is beneficial but does not fully normalize survival in all elderly patients with high-degree AV block, particularly those with comorbidities.
- Identifying prognostic factors is crucial for risk stratification and management in this patient population.
Abstract:
Permanent pacing can prevent recurrent symptoms and reduce mortality in elderly patients with symptomatic high-degree atrioventricular (AV) block. However, long-term survival with respect to comparable control subjects has not been well defined. In our study, relative long-term survival and prognostic predictors after permanent pacemaker implantation for symptomatic high-degree AV block were assessed among all residents of Olmsted County, Minnesota, who were > or = 65 years old. Of the 154 patients, 77 were men and 77 were women (mean age 80 +/- 7 years). Follow-up was 0.1 to 19.8 years (mean 4.2 +/- 2.8). Sixty-nine patients had isolated AV block and 85 had coexisting heart disease. Observed survival at 1, 3, 5, and 10 years was 85%, 68%, 52%, 21%, and 72%, 50%, 31%, 11% for patients with isolated AV block and patients with coexisting heart disease, respectively (p = 0.006). Observed survival in patients 65 to 79 years old with isolated AV block was comparable to age- and sex-matched cohorts (p = 0.53), but in patients aged > or = 80 years, it was less than that for control subjects (p = 0.014). In patients with coexisting heart disease, observed survival was less than that for control subjects in patients 65 to 79 years old (p < 0.001) and > or = 80 years (p < 0.001). Multivariate analysis identified congestive heart failure, chronic obstructive pulmonary disease, age, syncope, insulin-dependent diabetes mellitus, and male gender as independent predictors of increased mortality.