Key result
Pacemaker implantation in nonagenarians is linked to ~55% mortality, with procedural complications predicting death.
Why the study?
The increasing rate of pacemaker implantations and projected longer life expectancy highlight the need to analyze short- and long-term outcomes after pacemaker implantation in nonagenarians.
Cohort (n=172)
Pacemaker implantation in nonagenarians is procedurally safe, though post-procedural complications significantly impact survival in this frail population.
Answers are grounded in this paper and cite their sources.
PM implantation in nonagenarians requires individualized assessment; leaves open optimal selection and survival benefit in prospective studies.
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.
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Dang et al. (2018) conducted a cohort in Referred for pacemaker implantation (n=172). Pacemaker implantation was evaluated on total mortality. Pacemaker implantation in nonagenarians was associated with a 54.7% total mortality rate over 22.5 months, with post-procedural complications strongly predicting death.
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