Abstract 212: Clinical Profile and Outcome Following Implantation of Permanent Pacemakers and Cardioverter Defibrillators in the Nonagenarians and Centenarians
Background: As per the United Nations World Population prospectus, the life expectancy in the USA is 78.2 yrs. Even among the elderly geriatric population, the nonagenarians and centenarians are a rapidly growing segment. Given their advanced age, there is a tendency to withhold invasive procedures.
Aim: We aim to report our experience of permanent pacemakers (PPM) and implantable cardiac defibrillators (ICDs) therapies in geriatric patients (pts) >90 yrs age.
Methods: Since January 2007, clinical and outcome data of pts > 90 yrs age undergoing new PPM /ICD implantation or generator change/upgrade were prospectively collected. All procedures were performed in cardiac electrophysiology laboratory. New implants were performed using axillary vein approach. Pts were closely followed at regular intervals.
Results: There were 31 pts (24 F); mean age of 94 yrs (range 90 – 100) in our study. For PPM indication, 13 pts underwent new PPM implantation (3 single and 10 dual chambers), and 15 pts underwent generator change (2 single and 13 dual chambers). PPMs were implanted for complete heart block in 20 pts. Of the new PPM implantations 8 were performed using active fixation right ventricular leads. There were no acute lead dislodgements. Before new PPM implantation, temporary leads were inserted in 3 pts, 1 of whom developed pneumothorax. Among pts undergoing generator change, median age for initial PPM implant was 86 years. But, 2 pts had initial PPM implanted at age 96 and 91 yrs. No pts undergoing generator change had temporary lead insertion during the procedure. For ICD indication, 1 pt, age 94 yrs, underwent new ICD implantation using active fixation lead. 2 pts who had prior ICDs implantation at age 90 yrs and 88 yrs had unsuccessful attempts to upgrade to cardiac resynchronization device and only the generators were changed. Defibrillation thresholds were not tested in all 3 pts. At regular follow-ups over 3 yrs, all pts have been alive, and the devices have been functioning well. The pt with new ICD implantation had successful arrhythmia termination by antitachycardia pacing within 1 yr of implantation.
Conclusions: Cautious implantation of PPMs and ICDs and their generator change outs are safe and effective in the geriatric nonagenarians and centenarians pts.
- © 2010 by American Heart Association, Inc.