Related Experiment Video
Updated: Jul 14, 2026
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Survival and functional independence after implantation of a permanent pacemaker in octogenarians and nonagenarians.
W K Shen1, D L Hayes, S C Hammill
1Mayo Clinic, Rochester, Minnesota, USA.
Background:
The number of very elderly persons who are candidates for implantation of a permanent pacemaker is increasing, but the effect of cardiac pacing on long-term survival and functional variables has not been determined.
Objective:
To determine long-term survival after implantation of a permanent pacemaker in octogenarians and nonagenarians and to assess functional independence after such implantation.
Design:
Retrospective, population-based cohort study.
Setting:
Epidemiologic setting from an unselected population.
Patients:
157 octogenarians and nonagenarians who initially received a pacemaker between 1962 and 1988 and were followed through 1992.
Main Outcome Measures:
Overall mortality rate, functional capabilities, and placement in a nursing home.
Results:
Observed survival in patients with heart disease was significantly worse than that in age-and sex-matched controls (P < 0.001). Observed survival in community residents without heart disease was similar to that in controls (P > 0.2). Multivariable analysis identified congestive heart failure, chronic obstructive pulmonary disease, old age, syncope, cancer, and atrioventricular block as independent predictors of increased mortality. Symptoms decreased in 118 patients (75%) after pacemaker implantation. After implantation, 70 patients (45%) were permanently placed in nursing homes; this number is similar to the estimated probability of lifetime use of nursing homes from the National Mortality Followback Survey. Dementia developed or worsened in 51 patients (32%), and orthopedic disability occurred in 41 patients (26%).
Conclusions:
Normal relative survival in octogenarians and nonagenarians without heart disease is reassuring; the poor prognosis in patients with heart disease warrants careful evaluation of the methods and indications for cardiac pacing. Permanent pacing alleviates bradycardia-related symptoms. Placement in a nursing home and development or worsening of cardiac, neurologic, or orthopedic disabilities frequently occur after implantation of a permanent pacemaker in the very elderly.
Related Concept Videos
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:29Cardiomyopathy V: Interprofessional Care