Procedural safety and long‐term follow‐up after pacemaker implantation in nonagenarians. Issue 10 (22nd October 2018)

• Record Type: Journal Article
• Authors: Dang, Duc; Galand, Vincent; Loirat, Aurélie; Auffret, Vincent; Behar, Nathalie; Mabo, Philippe; Daubert, Jean‐Claude; Leclercq, Christophe; Martins, Raphaël P.
• Is Part Of: Clinical cardiology. Volume 41:Issue 10(2018)
• Page Start: 1315
• Page End: 1321
• Publication Date: 2018-10-22
• Subjects: complications -- nonagenarian -- pacemaker; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.23083
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract : Background: The rate of pacemaker (PM) implantations is constantly growing. Since life expectancy of the population is projected to increase, a large number of nonagenarian patients will need PM implantation. We aimed at analyzing short‐ and long‐term outcomes after PM implantation in nonagenarians. Methods: Patients aged ≥90 years referred for PM implantation from 2004 to 2017 were included. The primary clinical endpoint was total mortality. Secondary endpoints included procedure‐related and in‐hospital complications. Results: A total of 172 patients were included (92.6 ± 2.1 years, from 90.0 to 101.4 years). Procedure duration was 50.0 ± 19.7 minutes. Most of the patients had VVI devices implanted (143 pts, 83.1%) and mean hospital stay was 3.5 ± 1.5 days. Nine patients (5.2%) had short‐term device‐related complications and 29 patients (16.8%) had post‐procedural complications, non‐related to the implantation, including four leading to patients' death. During a follow‐up of 22.5 months (interquartile range: 7.3‐38.0), 94 patients (54.7%) died. Survival rates were 82.9% (95% confidence interval [CI]: 76.0‐88.0), 73.7% (95% CI: 65.7‐80.1) and 37.5% (95% CI: 27.5‐47.5) after 1, 2, and 5 years, respectively. The Charlson comorbidity index was a predictive factor of procedural complications (odds ratio = 1.33; 95% CI: 1.05‐1.69, P = 0.02) while having a complication (hazard ratio [HR] = 4.04; 95% CI: 1.79‐9.11, P = 0.001) and atrial fibrillation (HR = 1.63; 95% CI: [1.02‐2.63], P = 0.043) were predictors of post‐implantation death. Conclusion: PM implantation in nonagenarians is safe, with a low risk of procedural complications, but many comorbidities‐related complications can occur. Caution should be taken in this old and frail population since complications significantly impact patients' survival.