open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-08-24
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Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Maciej Dębski, Mateusz Ulman, Andrzej Ząbek, Krzysztof Boczar, Kazimierz Haberka, Marcin Kuniewicz, Jacek Lelakowski, Barbara Małecka
DOI: 10.5603/CJ.a2018.0093
·
Pubmed: 30155863
·
Cardiol J 2019;26(6):717-726.

open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-08-24

Abstract

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many
parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in
comparison to the age- and sex-matched general population, assess changes in baseline characteristics
over three decades of the inclusion period and determine the association between selected variables and
patient survival.
Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performed
between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter
university hospital.
Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time.
Compared to the general population, the observed survival was significantly inferior until 12 years post
DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed
survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics
over three decades revealed the following significant changes: more elderly patients, more female
patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter
(AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades.
In multivariate analysis male sex and higher age were the only variables significantly associated with
shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device
infection were not associated with survival.
Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associated
with survival were sex and baseline age at first implantation.

Abstract

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many
parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in
comparison to the age- and sex-matched general population, assess changes in baseline characteristics
over three decades of the inclusion period and determine the association between selected variables and
patient survival.
Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performed
between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter
university hospital.
Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time.
Compared to the general population, the observed survival was significantly inferior until 12 years post
DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed
survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics
over three decades revealed the following significant changes: more elderly patients, more female
patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter
(AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades.
In multivariate analysis male sex and higher age were the only variables significantly associated with
shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device
infection were not associated with survival.
Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associated
with survival were sex and baseline age at first implantation.

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Keywords

mortality, survival, risk factors, cardiac pacing, atrial fibrillation

About this article
Title

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Journal

Cardiology Journal

Issue

Vol 26, No 6 (2019)

Pages

717-726

Published online

2018-08-24

DOI

10.5603/CJ.a2018.0093

Pubmed

30155863

Bibliographic record

Cardiol J 2019;26(6):717-726.

Keywords

mortality
survival
risk factors
cardiac pacing
atrial fibrillation

Authors

Maciej Dębski
Mateusz Ulman
Andrzej Ząbek
Krzysztof Boczar
Kazimierz Haberka
Marcin Kuniewicz
Jacek Lelakowski
Barbara Małecka

References (29)
  1. Bradshaw PJ, Stobie P, Knuiman MW, et al. Life expectancy after implantation of a first cardiac permanent pacemaker (1995-2008): A population-based study. Int J Cardiol. 2015; 190: 42–46.
  2. Brunner M, Olschewski M, Geibel A, et al. Long-term survival after pacemaker implantation. Prognostic importance of gender and baseline patient characteristics. Eur Heart J. 2004; 25(1): 88–95.
  3. Flaker G, Greenspon A, Tardiff B, et al. Death in patients with permanent pacemakers for sick sinus syndrome. Am Heart J. 2003; 146(5): 887–893.
  4. Pyatt JR, Somauroo JD, Jackson M, et al. Long-term survival after permanent pacemaker implantation: analysis of predictors for increased mortality. Europace. 2002; 4(2): 113–119.
  5. Udo EO, van Hemel NM, Zuithoff NPA, et al. Prognosis of the bradycardia pacemaker recipient assessed at first implantation: a nationwide cohort study. Heart. 2013; 99(21): 1573–1578.
  6. Witt CM, Lenz CJ, Shih HH, et al. Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. J Cardiovasc Electrophysiol. 2017; 28(8): 924–930.
  7. Greenspon AJ, Patel JD, Lau E, et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures. J Am Coll Cardiol. 2012; 60(16): 1540–1545.
  8. Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project. Pacing Clin Electrophysiol. 2011; 34(8): 1013–1027.
  9. Proclemer A, Ghidina M, Gregori D, et al. Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07. Europace. 2010; 12(2): 202–209.
  10. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Europace. 2013; 15: 1070–1118.
  11. https://stat.gov.pl/en/topics/population/life-expectancy/life-expectancy-in-poland,1,3.html.
  12. Jahangir A, Shen WK, Neubauer SA, et al. Relation between mode of pacing and long-term survival in the very elderly. J Am Coll Cardiol. 1999; 33(5): 1208–1216.
  13. Jelić V, Belkić K, Djordjević M, et al. Survival in 1,431 pacemaker patients: prognostic factors and comparison with the general population. Pacing Clin Electrophysiol. 1992; 15(2): 141–147.
  14. Mayosi BM, Little F, Millar RN. Long-term survival after permanent pacemaker implantation in young adults: 30 year experience. Pacing Clin Electrophysiol. 1999; 22(3): 407–412.
  15. Connolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med. 2000; 342(19): 1385–1391.
  16. Liao JN, Chao TF, Tuan TC, et al. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing. Medicine (Baltimore). 2016; 95(35): e4668.
  17. Toff WD, Camm AJ, Skehan JD. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med. 2005; 353(2): 145–155.
  18. Uslan DZ, Tleyjeh IM, Baddour LM, et al. Temporal trends in permanent pacemaker implantation: a population-based study. Am Heart J. 2008; 155(5): 896–903.
  19. Marchandise S, Scavée C, le Polain de Waroux JB, et al. Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block. Europace. 2012; 14(4): 496–501.
  20. Nielsen JC, Thomsen PE, Højberg S, et al. DANPACE Investigators. A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome. Eur Heart J. 2011; 32(6): 686–696.
  21. Fored CM, Granath F, Gadler F, et al. Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study. Europace. 2008; 10(7): 825–831.
  22. Nowak B, Misselwitz B, Erdogan A, et al. Do gender differences exist in pacemaker implantation?--results of an obligatory external quality control program. Europace. 2010; 12(2): 210–215.
  23. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386(9989): 154–162.
  24. Lamas G, Lee K, Sweeney M, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002; 346(24): 1854–1862.
  25. Hercé B, Nazeyrollas P, Lesaffre F, et al. Risk factors for infection of implantable cardiac devices: data from a registry of 2496 patients. Europace. 2013; 15(1): 66–70.
  26. Greenspon AJ, Patel JD, Lau E, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011; 58(10): 1001–1006.
  27. Dębski M, Ulman M, Ząbek A, et al. Gender differences in dual-chamber pacemaker implantation indications and long-term outcomes. Acta Cardiol. 2016; 71(1): 41–45.
  28. Ulman M, Dębski M, Ząbek A, et al. Long-term follow-up of DDD pacing mode. Kardiol Pol. 2014; 72(6): 519–526.
  29. Deharo JC, Quatre A, Mancini J, et al. Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study. Heart. 2012; 98(9): 724–731.

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