1
|
Imberti JF, Mei DA, Fontanesi R, Gerra L, Bonini N, Vitolo M, Turco V, Casali E, Boriani G. Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices. J Clin Med 2023; 12:2599. [PMID: 37048682 PMCID: PMC10095352 DOI: 10.3390/jcm12072599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet. AIM To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients. METHODS All consecutive patients implanted with a CIED at our institution were prospectively enrolled. Follow-up visits were performed 2 weeks after CIED implantation for all patients, and then every 6 months for implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) patients and every 12 months for pacemaker (PM) patients. The adjudication of CIED-related infections was performed by two independent investigators and potential disagreement was resolved by a senior investigator. RESULTS Between September 2016 and August 2020, a total of 838 patients were enrolled (34.6% female; median age 77 (69.6-83.6); median PADIT score 2 (2-4)). PMs were implanted in 569 (68%) patients and ICD/CRT in 269 (32%) patients. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, five (0.6%) patients had a CIED-related infection and 212 (25.5%) patients died. Using multivariate Cox regression analysis, end-stage chronic kidney disease (CKD) requiring dialysis and therapy with corticosteroids was independently associated with a higher risk of infection (hazard ratio (HR): 14.20; 95% confidence interval (CI) 1.48-136.62 and HR: 14.71; 95% CI 1.53-141.53, respectively). Age (HR: 1.07; 95% CI 1.05-1.09), end-stage CKD requiring dialysis (HR: 6.13; 95% CI 3.38-11.13) and history of atrial fibrillation (HR: 1.47; 95% CI 1.12-1.94) were independently associated with all-cause death. CONCLUSIONS In a contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED-related infections was low.
Collapse
Affiliation(s)
- Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Davide Antonio Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Riccardo Fontanesi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Luigi Gerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Vincenzo Turco
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| |
Collapse
|
2
|
Causes of Heart Block in Young and Middle-Aged South Africans. Curr Probl Cardiol 2022:101247. [PMID: 35568083 DOI: 10.1016/j.cpcardiol.2022.101247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a paucity of data regarding the aetiology of atrioventricular heart block (AVB) in young and middle-aged patients, particularly from low- and middle-income countries. OBJECTIVE To determine the aetiology of AVB in patients ≤ 55 years treated with transvenous pacemakers in a low- or middle-income country. METHODS We performed a retrospective review of all patients who received a transvenous pacemaker for newly diagnosed AVB from 01/01/2013 to 31/12/2020 at Groote Schuur Hospital, Cape Town, South Africa. RESULTS One thousand one hundred one (1101) consecutive patients received a permanent transvenous pacemaker for AVB. One hundred thirty-six patients (12.4%) were ≤ 55 years. The study patients' mean (standard deviation) age was 41 (11) years, and 48.5% were female. Third-degree AV block was diagnosed in 73.5%, 2:1 AV block in 8.1%, and Mobitz Ι second degree AV block in 5.9%. The aetiology of AVB could be determined in 97/136 (71.3%) patients. Forty-three of 136 (31.6%) patients were post-surgical, and 16/136 (11.8%) patients had developed AVB from an acute myocardial infarction. Cardiac Magnetic Resonance (CMR) imaging was performed in 26 patients: cardiac sarcoidosis was diagnosed in 7/26 patients. No pathology could be identified in 10/26 patients who had CMR. The aetiology of AVB remained unknown in 39/136 patients (28.7%). CONCLUSION Prior valve surgery is the leading cause of AVB treated with a transvenous pacemaker in patients ≤ 55 years in this South African referral unit. Cardiac magnetic resonance imaging identified disease processes that require further management in many cases.
Collapse
|
3
|
Vaidya VR, Asirvatham R, Kowlgi GN, Dai MY, Cochuyt JJ, Hodge DO, Deshmukh AJ, Cha YM. Trends in Cardiovascular Implantable Electronic Device Insertion Between 1988 and 2018 in Olmsted County. JACC Clin Electrophysiol 2022; 8:88-100. [PMID: 34454890 PMCID: PMC9339254 DOI: 10.1016/j.jacep.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study sought to describe trends in cardiovascular implantable electronic device (CIED) insertion over the past 3 decades in Olmsted County. BACKGROUND Trends in CIED insertion in the United States have not been extensively studied. METHODS The Rochester Epidemiology Project is a medical records linkage system comprising the records of all residents of Olmsted County from 1966 to the present. CIED insertion between 1988 and 2018 was determined using International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Age- and sex-adjusted incidence rates, adjusted to the 2010 US White population, were calculated. Trends in incidence over time, across age groups, and between sex are estimated using Poisson regression models. RESULTS The age- and sex-adjusted incidence of device implants for the study period were as follows: overall CIED: 82.4 (95% CI: 79.2-85.6); permanent pacemaker (PPM): 62.9 (95% CI: 60.0-65.7); implantable cardioverter-defibrillator (ICD): 14.0 (95% CI: 12.6-15.3); and cardiac resynchronization therapy (CRT): 5.6 (95% CI: 4.7-6.4) per 100,000 per year. The overall incidence of CIED insertion increased between 1988 to 1993 and 2000 to 2005 and then decreased between 2000 to 2005 and 2012 to 218 (P < 0.0001). PPM and ICD insertion incidence followed these trends, whereas the incidence of CRT insertion increased between 2000 to 2005 and 2012 to 2018. CIED insertion incidence increased with age (P < 0.0001). CIED insertion incidence was greater in men (116.3 vs 57.3 per 100,000 per year in men vs women; P < 0.0001). The overall survival of CRT recipients improved (P = 0.0044). CONCLUSIONS The incidence values for PPM and ICD implants are decreasing, while the incidence of CRT implants is increasing. CIEDs are increasingly inserted in the elderly, men, and patients with higher comorbidities.
Collapse
Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Roshini Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA,Cardiovascular Research Institute and Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jordan J. Cochuyt
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - David O. Hodge
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yong Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
4
|
Paton MF, Gierula J, Jamil HA, Lowry JE, Byrom R, Gillott RG, Chumun H, Cubbon RM, Cairns DA, Stocken DD, Kearney MT, Witte KK. Optimising pacemaker therapy and medical therapy in pacemaker patients for heart failure: protocol for the OPT-PACE randomised controlled trial. BMJ Open 2019; 9:e028613. [PMID: 31320354 PMCID: PMC6661620 DOI: 10.1136/bmjopen-2018-028613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Permanent artificial pacemaker implantation is a safe and effective treatment for bradycardia and is associated with extended longevity and improved quality of life. However, the most common long-term complication of standard pacemaker therapy is pacemaker-associated heart failure. Pacemaker follow-up is potentially an opportunity to screen for heart failure to assess and optimise patient devices and medical therapy. METHODS AND ANALYSIS The study is a multicentre, phase-3 randomised trial. The 1200 participants will be people who have a permanent pacemaker for bradycardia for at least 12 months, randomly assigned to undergo a transthoracic echocardiogram with their pacemaker check, thereby tailoring their management directed by left ventricular function or the pacemaker check alone, continuing with routine follow-up. The primary outcome measure is time to all-cause mortality or heart failure hospitalisation. Secondary outcomes include external validation of our risk stratification model to predict onset of heart failure and quality of life assessment. ETHICS AND DISSEMINATION The trial design and protocol have received national ethical approval (12/YH/0487). The results of this randomised trial will be published in international peer-reviewed journals, communicated to healthcare professionals and patient involvement groups and highlighted using social media campaigns. TRIAL REGISTRATION NUMBER NCT01819662.
Collapse
Affiliation(s)
- Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Haqeel A Jamil
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Judith E Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Rowena Byrom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Richard G Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hemant Chumun
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Cheng CW, Wang CH, Chen WS, Wang CC, Cherng WJ. Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older. Aging Clin Exp Res 2019; 31:1001-1009. [PMID: 30259339 PMCID: PMC6589145 DOI: 10.1007/s40520-018-1044-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
Background There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. Aims We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. Methods and results From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2 (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m2 (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. Conclusions Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older.
Collapse
Affiliation(s)
- Chi-Wen Cheng
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC.
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Wei-Siang Chen
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC
| | - Chun-Chieh Wang
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Wen-Jin Cherng
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| |
Collapse
|
6
|
Gong IY, Tan NS, Ali SH, Lebovic G, Mamdani M, Goodman SG, Ko DT, Laupacis A, Yan AT. Temporal Trends of Women Enrollment in Major Cardiovascular Randomized Clinical Trials. Can J Cardiol 2019; 35:653-660. [DOI: 10.1016/j.cjca.2019.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/04/2019] [Accepted: 01/22/2019] [Indexed: 11/30/2022] Open
|
7
|
Li YJ, Zhang WW, Yang XX, Li N, Qiu XB, Qu XK, Fang WY, Yang YQ, Li RG. Impact of prior permanent pacemaker on long-term clinical outcomes of patients undergoing percutaneous coronary intervention. Clin Cardiol 2016; 40:205-209. [PMID: 27879000 DOI: 10.1002/clc.22645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/22/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The impact of permanent pacemaker (PPM) on long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) has not been studied. HYPOTHESIS PPM may increase heart failure (HF) burden on patients undergoing PCI. METHODS We recruited consecutive patients undergoing PCI and carried out a nested case-control study. Patients with confirmed PPM undergoing first PCI were identified and matched by age and sex in 1:1 fashion to patients without PPM undergoing first PCI. Clinical data were collected and analyzed. The primary endpoint outcomes were all-cause mortality and hospitalization for HF. RESULTS The final analysis included 156 patients. The mean follow-up period was 4.6 ± 2.9 years. The overall all-cause mortality was 21.15%, without significant difference between the 2 groups (21.79% vs 20.51%; P = 0.85). However, the rate of HF-related hospitalization was significantly higher in patients with PPM than in controls (26.92% vs 10.26%; P = 0.008). After adjustment for hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, left ventricular ejection fraction, brain natriuretic peptide, and acute coronary syndrome (ACS), PCI patients with PPM were still associated with a greater hospitalization rate for HF (odds ratio: 4.31, 95% confidence interval: 0.94-19.80, P = 0.061). Further analysis in the ACS subgroup showed VVI-mode pacing enhanced the risk for HF-associated hospitalization (adjusted odds ratio: 8.27, 95% confidence interval: 1.37-49.75, P = 0.02). CONCLUSIONS PPM has no effect on all-cause mortality in patients undergoing first PCI but significantly increases the HF-associated hospitalization rate, especially in ACS patients.
Collapse
Affiliation(s)
- Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Wei Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Xiao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Kai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Yi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
8
|
Rajaeefard A, Ghorbani M, Babaee Baigi MA, Tabatabae H. Ten-year Survival and Its Associated Factors in the Patients Undergoing Pacemaker Implantation in Hospitals Affiliated to Shiraz University of Medical Sciences During 2002 - 2012. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 17:e20744. [PMID: 26734484 PMCID: PMC4698316 DOI: 10.5812/ircmj.20744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 05/22/2015] [Accepted: 06/21/2015] [Indexed: 11/28/2022]
Abstract
Background: Heart failure is a prevalent disease affecting about 4.9 million people in the U.S. and more than 22 million individuals worldwide. Using electric pacemaker is the most common treatment for the patients with heart conduction problems. The present study aimed to determine the factors affecting survival in the patients undergoing pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences. Objectives: The aim of the present study was to identify the factors affecting the survival of the patients suffering from arrhythmia. Patients and Methods: This retrospective survival analysis was conducted on all 1207 patients with heart failure who had undergone permanent pacemaker implantation in the hospitals affiliated to Shiraz University of Medical Sciences from 2002 to 2012. The data were analyzed using non-parametric methods such as Kaplan-Meier method, life table, and Cox regression model. The risk factors of mortality were determined using multivariate Cox proportional hazards method. Results: Survival data were available for 1030 (80%) patients (median age = 71 years [5th to 95th percentile range: 26 - 86 years]) and follow-up was completed for 84.28% of them. According to the results, 56% of the patients had received dual-chamber systems, while 44% had been implanted by single-chamber ventricular systems. Moreover, sick sinus syndrome and pacemaker mode were independent predictors of increased mortality. Conclusions: In this study, sick sinus syndrome and pacemaker mode followed by syncope were independently associated with increased mortality.
Collapse
Affiliation(s)
- Abdolreza Rajaeefard
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Abdolreza Rajaeefard, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7137251001, Fax: +98-7137260225, E-mail:
| | - Mohammad Ghorbani
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Hamidreza Tabatabae
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
| |
Collapse
|
9
|
Udo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Prognosis of the bradycardia pacemaker recipient assessed at first implantation: a nationwide cohort study. Heart 2013; 99:1573-8. [DOI: 10.1136/heartjnl-2013-304445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Fraccaro C, Napodano M, Tarantini G. Conduction disorders in the setting of transcatheter aortic valve implantation: a clinical perspective. Catheter Cardiovasc Interv 2013; 81:1217-23. [DOI: 10.1002/ccd.24713] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 10/12/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Chiara Fraccaro
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
| | - Massimo Napodano
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
| | - Giuseppe Tarantini
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
| |
Collapse
|
11
|
OBEID KARAMM, SZPUNAR SUSAN, KHATIB RIAD. Long-Term Outcomes of Cardiovascular Implantable Electronic Devices in Patients with Staphylococcus aureus Bacteremia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:961-5. [DOI: 10.1111/j.1540-8159.2012.03438.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Udo EO, van Hemel NM, Zuithoff NPA, Kelder JC, Crommentuijn HA, Koopman-Verhagen AM, Voskuil T, Doevendans PAFM, Moons KGM. Long-term outcome of cardiac pacing in octogenarians and nonagenarians. Europace 2011; 14:502-8. [DOI: 10.1093/europace/eur329] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Tzikas A, van Dalen BM, Van Mieghem NM, Gutierrez-Chico JL, Nuis RJ, Kauer F, Schultz C, Serruys PW, de Jaegere PPT, Geleijnse ML. Frequency of conduction abnormalities after transcatheter aortic valve implantation with the Medtronic-CoreValve and the effect on left ventricular ejection fraction. Am J Cardiol 2011; 107:285-9. [PMID: 21129715 DOI: 10.1016/j.amjcard.2010.09.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/10/2010] [Accepted: 09/14/2010] [Indexed: 11/27/2022]
Abstract
New conduction abnormalities occur frequently after transcatheter aortic valve implantation (TAVI). The relation between new conduction disorders and left ventricular (LV) systolic function after TAVI is unknown. The purpose of the present prospective, single-center study was to investigate the effect of TAVI on LV systolic function in relation to TAVI-induced conduction abnormalities. A total of 27 patients had undergone electrocardiography and transthoracic echocardiography the day before and 6 days after TAVI with the Medtronic-CoreValve system. The LV ejection fraction (EF) was calculated using the biplane Simpson method. The systolic mitral annular velocities and longitudinal strain were measured using speckle tracking echocardiography. After TAVI, 18 patients (67%) had new conduction abnormalities; 4 (15%) had a new paced rhythm and 14 patients (52%) had new left bundle branch block. In the patients with new conduction abnormalities, the EF decreased from 47 ± 12% to 44 ± 10%. In contrast, in those without new conduction abnormalities, the EF increased from 49 ± 12% to 54% ± 12%. The change in EF was significantly different among those with and without new conduction abnormalities (p <0.05). In patients without new conduction abnormalities, an improvement was found in the systolic mitral annular velocities and longitudinal strain (p <0.05). In contrast, in patients with new conduction abnormalities, the changes were not significant. In conclusion, the induction of new conduction abnormalities after TAVI with the Medtronic-CoreValve was associated with a lack of improvement in LV systolic function.
Collapse
Affiliation(s)
- Apostolos Tzikas
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
RamÃrez P, Arizo D, Cortes C, Garcia MA, De La Plata AM, Salinas G, Talavera M, Bonastre JM. SURVIVAL OF NONAGENARIAN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT FOR SYMPTOMATIC CARDIAC RHYTHM DISTURBANCES IN NEED OF A PACEMAKER. J Am Geriatr Soc 2009; 57:1126-8. [DOI: 10.1111/j.1532-5415.2009.02294.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Temporal trends in permanent pacemaker implantation: a population-based study. Am Heart J 2008; 155:896-903. [PMID: 18440339 DOI: 10.1016/j.ahj.2007.12.022] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 12/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited data exist regarding temporal trends in permanent pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period. METHODS All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population. RESULTS Adjusted implantation incidence rates increased from 36.6 per 100,000 person-years during 1975 to 1979 to 99 per 100,000 person-years during 2000 to 2004 (P < .0001). After adjusting for age (hazard ratio [HR] 1.06 per year), male sex (HR 1.28), and implant year (HR 0.98), the HR for death among PPM recipients by CCI quartiles was 1.0, 1.79, 2.29, and 3.91 for CCI of 0 to 1 (reference), 2 to 3, 4 to 6, and > or = 7, respectively (P < .0001). Overall, PPM recipients had higher CCI than the population-based controls (P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases (P < .0001) and from 3.06 to 3.54 among the age- and sex-matched controls (P = .047). CONCLUSIONS There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.
Collapse
|
16
|
Vanerio G, Vidal JL, Fernández Banizi P, Banina Aguerre D, Viana P, Tejada J. Medium- and long-term survival after pacemaker implant: Improved survival with right ventricular outflow tract pacing. J Interv Card Electrophysiol 2008; 21:195-201. [DOI: 10.1007/s10840-008-9238-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/29/2008] [Indexed: 11/29/2022]
|
17
|
ZHANG XUEHUA, CHEN HUA, SIU CHUNGWAH, YIU KAIHANG, CHAN WINGSZE, LEE KATHYL, CHAN HONWAH, LEE STEPHENW, FU GUOSHENG, LAU CHUPAK, TSE HUNGFAT. New-Onset Heart Failure After Permanent Right Ventricular Apical Pacing in Patients with Acquired High-Grade Atrioventricular Block and Normal Left Ventricular Function. J Cardiovasc Electrophysiol 2008; 19:136-41. [DOI: 10.1111/j.1540-8167.2007.01014.x] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Ghani SN, Kirkpatrick JN, Spencer KT, Smith GL, Burke MC, Kim SS, Desai AD, Knight BP. Rapid assessment of left ventricular systolic function in a pacemaker clinic using a hand-carried ultrasound device. J Interv Card Electrophysiol 2006; 16:39-43. [PMID: 17051437 DOI: 10.1007/s10840-006-9011-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pacemaker recipients with left ventricular (LV) dysfunction are potential candidates for upgrades to implantable defibrillators or cardiac resynchronization devices. This study sought to determine if a hand-carried ultrasound (HCU) device could be used for rapid, inexpensive identification of LV dysfunction in a busy pacemaker clinic. MATERIALS AND METHODS Eighty patients undergoing routine pacemaker check were enrolled. Patients underwent HCU imaging in the sitting position during device interrogation, by an internist who had 20 h of didactic training and 20 practice examinations. LV dysfunction was defined as ejection fraction (EF) <40%. Patients also underwent echocardiography limited to EF assessment by a sonographer using a full-feature platform. RESULTS The mean age was 75 +/- 13 years; 49% were female. Coronary artery disease was present in 29%; 82% were NYHA class I or II. At the time of HCU imaging, 48% of patients were receiving RV pacing. HCU images were interpretable in 91% (73/80) and required 3.7 +/- 0.9 min to complete. Based on the full-feature echo, LV dysfunction prevalence was 17/80 (21%); 25% of these patients were NYHA class I. The sensitivity of the HCU exam was 75%, specificity was 91%, negative predictive value was 93%, positive predictive value was 71%, and accuracy was 88%. CONCLUSIONS HCU screening in a pacemaker clinic by a non-cardiologist can rapidly and accurately identify pacemaker recipients with at least moderate LV dysfunction who might be candidates for device upgrades. Ventricular dyssynchrony associated with RV pacing does not limit HCU identification of LV dysfunction.
Collapse
Affiliation(s)
- Syed Nasir Ghani
- Section of Cardiology, Department of Internal Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Schmidt B, Brunner M, Olschewski M, Hummel C, Faber TS, Grom A, Giesler U, Bode C, Zehender M. Pacemaker therapy in very elderly patients: long-term survival and prognostic parameters. Am Heart J 2003; 146:908-13. [PMID: 14597943 DOI: 10.1016/s0002-8703(03)00453-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Permanent pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. However, augmented life expectancy and increasing health care expenditures have led to questions concerning the routine use of electrotherapy in very elderly patients. This study is aimed at assessing data on the actual number, characteristics, and survival of patients requiring pacing therapy at age > or =80 years. METHODS Between 1971 and 2000, 1588 patients aged > or =80 years completed a standardized 6- to 12-month follow-up after pacemaker (PM) implantation, resulting in a total of 5244 patient years. Kaplan-Meier analyses were computed to visualize survival differences in various subgroups and implantation periods. RESULTS Today, patients aged > or =80 years account for 32% of all PM implantations. An increasing 5-year survival after PM implantation to the current rate of 66% was found, compared to 37% and 47% in the previous decades. Based on a mean survival time of 8 years, clinical symptoms can be effectively treated with costs of < or =500 dollars per patient per year. Prognostic parameters were the decade of implantation (relative risk [RR] 0.80, CI 0.67-0.96, P < or =.02), a history of presyncope (RR 0.73, CI 0.57-0.95, P < or =.02), and male sex (RR 1.20, CI 1.04-1.40, P < or =.02). However, none of these parameters can be recommended for estimating outcome or for guiding device selection. CONCLUSIONS Patients aged > or =80 years account for an increasing portion of PM implantations. Considering the remaining life expectancy of 8 years in these patients, PM therapy is a clinically and economically effective therapeutic option to control bradyarrhythmia-related symptoms.
Collapse
Affiliation(s)
- Boris Schmidt
- Medizinische Klinik III (Kardiologie und Angiologie), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Bourke JP. Atrioventricular block and problems with atrioventricular conduction. Clin Geriatr Med 2002; 18:229-51. [PMID: 12180245 DOI: 10.1016/s0749-0690(02)00007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This chapter has summarized briefly the current state of our knowledge on the incidence, etiology, presentation, investigation, and management of patients with AV block. The scope of the material covered has been widened intentionally to include a plethora of AV-conduction abnormalities because of the increases in the understanding of their clinical importance and contribution to left ventricular dysfunction. Under this heading, the critical importance of heart rate, maintenance of AV synchrony, and the sequence of ventricular activation and relaxation have been introduced and summarized briefly. The authors make a strong plea that, in the future, the reader consider AV-conduction abnormalities to be the parent topic, with the more-traditional, narrower subject of AV block forming a subunit thereof.
Collapse
Affiliation(s)
- John P Bourke
- Department of Cardiology, University of Newcastle upon Type, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
| |
Collapse
|
21
|
Abstract
OBJECTIVE To review (1) the physiologic changes of aging that may lead to the need for a permanent pacemaker; (2) the current standard indications for pacemaker implantation as reported in expert guidelines; (3) newer investigational uses of pacemakers; (4) advances in pacemaker technology; and (5) cost-effectiveness of permanent pacing. DATA SOURCES Computer-assisted search of the English language literature (MEDLINE database), manual search of articles bibliographies, and review of data provided by a major pacemaker manufacturer. DESIGN Pertinent articles were reviewed and data extracted. Studies and data involving older persons were emphasized, and these data were extracted and presented. RESULTS Abnormalities in impulse generation and conduction are common in older people and form the substrate for the need of pacemaker implantation. Pacemaker use is high in older people, with an estimated 70 to 80% of all permanent pacemakers implanted in individuals aged 65 years and older. The hemodynamic changes of aging include a reduction of ventricular compliance and increased contribution of atrial contraction to ventricular filling. Pacemakers that maintain synchrony between atria and ventricles may, therefore, be particularly advantageous in older adults. Recent studies have validated this theoretical reasoning. Chronotropic incompetence is common in older people, and rate responsive ventricular pacing has been shown to improve quality of life compared with fixed rate devices in older patients. Sequential, dual chamber pacemakers reduce the symptoms of pacemaker syndrome and recurrences of atrial fibrillation in certain groups of patients. Potential utility of permanent pacing is being investigated in patients with severe left ventricular dysfunction, markedly prolonged atrioventricular conduction time, hypertrophic and dilated cardiomyopathy, and after cardiac transplantation. Biventricular pacing as therapy for severe heart failure is in the very early phases of investigation. Newer implantable pacemakers provide a host of technological options but are somewhat more expensive and require more frequent follow-up. Controversies still exist regarding the need for pacemakers in certain clinical conditions but are decreasing as new high quality studies are completed. CONCLUSIONS Permanent pacing is highly cost-effective, safe, and simple to perform. Pacemakers are implanted in patients with sinus node dysfunction, acquired (both native and postsurgical) atrioventricular block, some forms of neurally mediated syndromes, fascicular blocks, and, occasionally, for the prevention of supraventricular or ventricular tachyarrhythmias. Although pacemakers are implanted in individuals of all ages, they are most often utilized in older adults; it is estimated that 70 to 80% of all pacemakers are implanted in patients 65 years of age or older. This is attributable to an increase in abnormalities of impulse generation and conduction with advancing age. Dual chamber pacemakers that maintain synchrony between atria and ventricles are preferable in older patients because of the increased contribution of atrial contraction to ventricular filling in this age group. This theoretical advantage has been confirmed by prospective studies in limited patient subgroups.
Collapse
Affiliation(s)
- G Gregoratos
- Cardiology Consultation Services, UCSF Stanford Medical Center, San Francisco, CA 94143-0327, USA
| |
Collapse
|
22
|
Jahangir A, Shen WK, Neubauer SA, Ballard DJ, Hammill SC, Hodge DO, Lohse CM, Gersh BJ, Hayes DL. Relation between mode of pacing and long-term survival in the very elderly. J Am Coll Cardiol 1999; 33:1208-16. [PMID: 10193718 DOI: 10.1016/s0735-1097(99)00005-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study analyzes the relationship between pacing mode and long-term survival in a large group of very elderly patients (> or = 80 years old). BACKGROUND The relationship between pacing mode and long-term survival is not clear. Because the number of very elderly who are candidates for pacing is increasing, issues related to pacemaker (PM) use in the elderly have important clinical and economic implications. METHODS We retrospectively reviewed 432 patients (mean age, 84.5+/-3.9 years) who received their initial PM (ventricular in 310 and dual chamber in 122) between 1980 and 1992. Follow-up was complete (3.5+/-2.6 years). Observed survival was estimated by the Kaplan-Meier method. Age- and gender-matched cohorts from the Minnesota population were used for expected survival. Log-rank test and Cox regression hazard model were used for univariate and multivariate analyses. RESULTS Patients with ventricular PMs appeared to have poor overall survival compared with those with dual-chamber PMs. Observed survival after PM implantation in high grade atrioventricular block (AVB) patients was significantly worse than expected survival of the age- and gender-matched population (p < 0.0001), whereas observed survival of patients with sinus node dysfunction was not significantly different from expected survival of the matched population (p = 0.413). By univariate analysis, ventricular pacing in patients with AVB appeared to be associated with poor survival compared with dual-chamber pacing (hazard ratio [HR] 2.08; 95% confidence interval [CI] 1.33 to 3.33). After multivariate analysis, this difference was no longer significant (HR 1.41; 95% CI 0.88 to 2.27). Independent predictors of all-cause mortality were number of comorbid illnesses, New York Heart Association functional class, left ventricular depression and older age at implant. Pacing mode was not an independent predictor of overall survival. Older age at implantation, diabetes mellitus, dementia, history of paroxysmal atrial fibrillation and earlier year of implantation were independent predictors of ventricular pacemaker selection. CONCLUSIONS After PM implantation, long-term survival among very elderly patients was not affected by pacing mode after correction of baseline differences. Selection bias was present in pacing mode in the very elderly, with ventricular pacing selected for sicker and older patients, perhaps partly explaining the apparent "beneficial impact on survival" observed with dual-chamber pacing.
Collapse
Affiliation(s)
- A Jahangir
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Lewis JW, Webb CR, Pickard SD, Lehman J, Jacobsen G. The increased need for a permanent pacemaker after reoperative cardiac surgery. J Thorac Cardiovasc Surg 1998; 116:74-81. [PMID: 9671900 DOI: 10.1016/s0022-5223(98)70245-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The requirement for permanent pacemaker implantation after most initial cardiac surgical procedures generally is less than 3%. To identify the incidence and factors related to permanent pacemaker need after repeat cardiac surgery, we retrospectively studied 558 consecutive patients undergoing at least one repeat cardiac operation. METHOD Univariable and multivariable analyses of comorbidity, preoperative catheterization values, and operative data were performed to identify factors related to pacemaker implantation. RESULTS In this group, 54 patients (9.7%) required a permanent pacemaker. A multivariable model showed a relationship between a permanent pacemaker and tricuspid valve replacement/annuloplasty associated with aortic/mitral valve replacement, preoperative endocarditis, increasing number of reoperations, the degree of hypothermia during cardiopulmonary bypass, and advanced age. Additional univariable predictors of pacemaker need included multiple valve replacement, increased cardiopulmonary bypass and aortic crossclamp times, and aortic valve replacement. Over 90% of patients who have or have not received permanent pacemaker implantation were in New York Heart Association class I to II, with a mean follow-up time of 6 years. Kaplan-Meier survival curves were statistically similar for both groups at 5 and 10 years after the operation. CONCLUSION Permanent pacemaker implantation was required in 9.7% of patients undergoing repeat cardiac surgery. This represented approximately a fourfold increase compared with similar primary operations reported in other series. Factors strongly related to this need included valve replacement, preoperative endocarditis, number of reoperations, advanced age, and degree of hypothermia during cardiopulmonary bypass. The need for a permanent pacemaker after reoperations did not result in significant long-term impairment of functional status or longevity compared with those who did not require a permanent pacemaker.
Collapse
Affiliation(s)
- J W Lewis
- Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, Detroit, Mich 48202, USA
| | | | | | | | | |
Collapse
|
24
|
Brady PA, Shen WK, Neubauer SA, Hammill SC, Hodge DO, Hayes DL. Pacing mode and long-term survival in elderly patients with congestive heart failure: 1980-1985. J Interv Card Electrophysiol 1997; 1:193-201. [PMID: 9869971 DOI: 10.1023/a:1009760605077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dual-chamber pacing may improve short-term hemodynamics and functional class in some patients with congestive heart failure, even in the absence of conventional indications for pacemaker implantation. However, the impact of different pacing modes on survival of patients with congestive heart failure is controversial. In this retrospective study we analyzed survival data from 546 elderly patients, aged 70 years and older, who underwent implantation of a permanent dual-chamber (DDD, n = 62, DVI, n = 102) or single-chamber (VVI) pacemaker (n = 382) between 1980 and 1985. Survival was further analyzed according to the presence of absence of congestive heart failure, and pacemaker mode (DDD vs. DVI vs. VVI). Overall, dual-chamber pacing (DDD and DVI) was associated with a more favorable long-term outcome when compared with single-chamber ventricular pacing, although differences were only significant for DDD pacing (P = 0.002). When patients with and without preexisting congestive heart failure were analyzed separately, survival following dual-chamber pacing (DDD and DVI) was significantly better than survival following single-chamber pacing in patients without congestive heart failure (P = 0.03), but not in patients with preexisting heart failure (P = 0.139). When patients were analyzed according to the electrophysiological indication for pacemaker implantation, overall survival of patients with AV block (P = 0.0025) but not sinus node dysfunction (P = 0.346) was improved with dual-chamber pacing. This survival advantage in patients with AV block following dual-chamber pacing was lost in the presence of heart failure (P = 0.11). These findings suggest that dual-chamber pacing, in particular DDD pacing, improves the survival in elderly patients without preexisting congestive heart failure. In contrast to the short-term hemodynamic improvement observed in selected patients with congestive heart failure, dual-chamber pacing in elderly patients with congestive heart failure, paced for conventional indications, is not associated with improved survival when compared with single-chamber ventricular pacing.
Collapse
Affiliation(s)
- P A Brady
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Mayo Foundation, Rochester, Minnesota 55905, USA
| | | | | | | | | | | |
Collapse
|