Comparison of prognosis and safety of pacemaker implantation in patients aged less than or 85 years and older

• Published in: Journal of interventional cardiac electrophysiology Vol. 61; no. 1; pp. 171 - 179
• Main Authors: Matsuda, Yasuhiro, Masuda, Masaharu, Asai, Mitsutoshi, Iida, Osamu, Okamoto, Shin, Ishihara, Takayuki, Nanto, Kiyonori, Kanda, Takashi, Tsujimura, Takuya, Okuno, Shota, Hata, Yosuke, Uematsu, Hiroyuki, Mano, Toshiaki
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021; Springer Nature B.V
• Subjects: Bradycardia; C-reactive protein; Cardiology; Complications; Confidence intervals; Death; Implantation; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Pacemakers; Prognosis; Pacemaker implantation; Elderly; Bradycardia
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-020-00797-9

Purpose Cardiac conduction disturbance necessitating pacemaker implantation is common among elderly patients. However, patients often have comorbidities and increased frailty which may result in limited life prognosis and a high rate of procedure-related complications. We evaluated pacemaker implantation in older patients by comparing life prognosis and complication rate in patients aged ≥ and < 85 years. Methods We retrospectively enrolled 262 consecutive patients who underwent initial pacemaker implantation for bradycardia (age, 77 ± 10 years old; male, 132 (50%); dual chamber pacemaker, 222 (85%) patients). Acute and long-term outcomes were compared between patients aged ≥ 85 and < 85 years. Primary outcome was a composite of all-cause death and severe procedure-related complications. Results Seven (14%) patients aged ≥ 85 years ( n  = 50; 19%) were non-ambulatory. During 2-year follow-up, primary outcome (death or severe complication) occurred in 47 (18%). Freedom from primary outcome was similar between age groups (81.6% versus 80.8%; p  = 0.98). Freedom from all-cause death and from severe complication in the study period were also similar (all-cause death, 91.6% versus 88.7%, p  = 0.70; severe complication, 89.7% versus 91.5%, p  = 0.75). On multivariate analysis, sick sinus syndrome (hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.1–6.4, p  = 0.03), immunosuppressant use (HR 21 (95% CI 3.3–134), p  < 0.01), and high C-reactive protein (HR 1.5 (95% CI 1.2–1.9), p  < 0.01) were independent predictors of primary outcome. Conclusions Life prognosis and severe complication rates after pacemaker implantation were similar between patients aged ≥ and < 85 years.