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The natural history of long-term cardiac pacing
Insights
Pacemaker patients with complete heart block have a 61% survival rate. Left ventricular function is the most critical factor influencing long-term survival in patients with permanent pacemakers.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Permanent pacemakers are crucial for managing arrhythmias like complete heart block.
- Understanding long-term outcomes is essential for patient management and device development.
Purpose of the Study:
- To analyze the long-term survival rates and causes of death in patients with pacemakers.
- To identify factors influencing survival in patients with permanent pacemakers.
Main Methods:
- Actuarial analysis of survival data from 504 patients who received pacemakers over ten years.
- Evaluation of patient demographics, pre-pacing characteristics, and causes of death.
Main Results:
- Overall survival rate was 61% (306 out of 504 patients).
- Annual attrition rates were 9.4% for the first five years, decreasing to 7% for the second five years.
- Congestive heart failure and advanced age negatively impacted survival; Stokes-Adams attacks, low initial pulse rate, and prolonged QRS duration did not.
- Cardiac problems accounted for 71% of deaths.
Conclusions:
- Long-term survival in pacemaker patients is significantly influenced by left ventricular function.
- Congestive heart failure and advanced age are key predictors of decreased survival.
- Pacemaker therapy improves survival for patients with complete heart block and other arrhythmias, but cardiac issues remain the primary cause of mortality.
Abstract:
During the past ten years, 504 patients have received one or more pacemakers for complete heart block or other arrhythmia. Of these patients, 306 (61%) are alive. Actuarial analysis shows a steady attrition of 9.4% per year for the first five years, decreasing to 7% per year for the second five years. The overall survival was decreased for patients with congestive heart failure and advanced age and was not affected by the history of Stokes-Adams attacks, initial pulse rate below 50 per minute, or a QRS duration greater than 0.12 second prior to pacing. Cardiac problems were the primary cause of death in 71% of the patients. The natural history of patients with permanent pacemakers depends, more than any other factor, on the function of the left ventricle.