Abstract 19486: Younger Age at Time of Pacemaker Implantation is Associated With Worse Survival
Background: Pacemakers are the mainstay treatment for symptomatic bradycardia but pacing from the right ventricle apex can cause deleterious ventricular dysynchrony and lead to heart failure and increased risk for atrial and ventricular arrhythmia. The aim of this large observational population cohort study was to investigate firstly the effect of pacing on survival and secondly if survival was determined by age at the time of implant.
Methods: This study was done in Tayside, Scotland (population approximately 400 000) using data linked anonymously by a community health index number from the Tayside Pacing Registry (1993–2009), the Tayside echocardiogram database (> 90,000 echos), dispensed prescribing database and outcome data maintained by the Health Informatics Centre (HIC). Observed survival was estimated by the Kaplan-Meier method. Age- and sex-matched cohorts from the Tayside population were used for expected survival. Cox proportional hazards model was used to examine the effects pacemaker insertion using age, sex, pacing mode, pacing indication, ischemic heart disease, stroke and left ventricular systolic dysfunction as co-variants.
Results: 3515 patients (mean age at implant 74.3±13.1 yrs; 45% male) received pacemakers (54% DDD, 46% VVI, 1% AAI) in the 16 year period. There were 1950 deaths with 18,559 patient-years of follow-up. Pacing was associated with poor survival (Hazard ratio (HR) 1.31; 95% confidence interval [CI] 1.23 to 1.40) for the entire cohort. All cause mortality was inversely related to age at time of implant: age 40–50yrs (HR 2.85; 95% CI 1.01–7.90); age 51–60yrs (HR 2.70; 95% CI 1.80–4.08); age 61–70yrs (HR 1.72; 95% CI 1.42–2.08); age 71–80yrs (HR 1.28; 95% CI1.15–1.43); age 80–90yrs (HR 1.29; 95% CI 1.16–1.43); age> 90 yrs (HR 0.91; 95% CI 0.74 – 1.13). Pacing mode and conduction disturbance were not independent predictors of overall survival.
Conclusions: This large population cohort study showed that right ventricular pacing may be associated with reduced survival with younger patients being at greatest risk. There was no increased risk of mortality above the age of 90 years. Further research is needed into ameliorating the long-term effects of pacing, especially in the young
- © 2010 by American Heart Association, Inc.