101 Non-modifiable factors affecting outcome of bradyarrhythmia device implantation

• Published in: Heart (British Cardiac Society) Vol. 109; no. Suppl 3; pp. A112 - A113
• Main Authors: Warraich, Mazhar, Ayyaz, Dawar, Sunni, Nadia, Haggag, Ahmed
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 02.06.2023; BMJ Publishing Group LTD
• Subjects: Bradyarrhythmia; Cardiac arrhythmia; Cardiac Rhythm Management; Complete Heart Block; Heart; Mortality; Pacemaker; Sinuses; Statistical significance; Transplants & implants
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-BCS.101

Background and AimsComplete heart block has higher mortality compared to arrhythmogenic syncope treated with pacing devices.1 We aimed to look how indication and other factors affect mortality.MethodsWith a minimum two-year prospective follow-up withRetrospective examination of 700 consecutive novel standard bradyarrhythmia devices were implanted between 01/01/2016 to 28/02/2021 allowed for minimum of two-year follow-up for surviving patients. Results were analysed with Kaplan-Meier survival curves, Hazard Ratios (HR) and Risk Ratios (RR).ResultsThe majority were in-patient (377/700; 53.9%) implants with 461 (65.9%) dual lead DDD and 239 (34.1%) single lead VVI and AAI bradyarrhythmia device implants. A inpatient implant had a HR 2.16 (95% CI 1.71-2.73, p <0.0001) with a HR 3.48 (95% CI 2.28-5.32, p <0.0001) for death in 1 year (figure 1). Similarly, VVI implants had an overall HR 2.89 (95% CI 2.22-3.76, p<0.0001) and HR 3.66 (95% CI 2.33-5.78, p<0.0001) within 1 year (figure 2).An indication of complete heart block (OR 1.50 95% CI 1.13-1.99) and asystole with sinus arrest (OR 3.2, 95% CI 1.14-9.00) proved a higher mortality in less than 12 months. Symptomatic bifasicular or trifasicular block and tachybrady syndrome demonstrated a trend towards higher mortality but did not reach statistical significance. As previously demonstrated,1 sinus node dysfunction, sinus bradycardia and carotid hypersensitivity had lower mortality at 12 months (OR 0.38 95% CI 0.22-0.66). Interestingly, second degree heart block had reduced odds for mortality at 12 months but did not reach statistical significance.ConclusionInpatient implantation, indication of complete heart block and sinus arrest were found to be important factors for early mortality. There is growing evidence of non-modifiable factors at implant that affect mortality which should be considered as part of informed consenting process prior to device implantation.2Abstract 101 Figure 1Kaplan-Meier Curve for survival for inpatient and outpatient bradyarrythmia device implantationAbstract 101 Figure 2Kaplan-Meier survival for VVI and DDD bradyarrythmia device implantationAbstract 101 Figure 3Risk Ratios for death within 12 months by indication for bradycardia device implantationConflict of InterestNil