© 2002 by European Society of Cardiology
REGULAR ARTICLES
Long-term survival after permanent pacemaker implantation: analysis of predictors for increased mortality
1The Cardiothoracic Centre Liverpool, U.K.; 2Basildon Hospital Basildon, U.K.
Manuscript submitted 29 May 2001. Accepted after revision 10 January 2002.
Correspondence: Dr J. R. Pyatt, The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, U.K. E-mail: Jason.Pyatt{at}ccl-tr.nwest.nhs.uk or jpyat{at}hotmail.com
Key Words: Permanent pacemaker, survival, risk factors
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Aims |
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 Top Aims Methods and ResultsConclusionsReferences |
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To determine long-term time-related survival and evaluate risk factors for increased mortality in patients following their first permanent pacemaker implantation.
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Methods and Results |
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TopAimsMethods and ResultsConclusionsReferences |
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Analysis of patient records from implant to follow-up. Patient-specific time-lines were constructed to date of last review or death. Observed survival was estimated by event-free analysis using the Kaplan–Meier method. Expected survival was derived from age- and gender-matched cohorts. Risk factors for mortality were sought using the multivariate Cox proportional hazards method and risk ratios estimated. Eight hundred and thirty-three patients underwent implantation of their first permanent pacemaker from April 1992 to January 1994, and were locally followed up. Survival data were available for 803 (96·4%) patients (median age, 77·3 years [5th to 95th centile range: 53·5 to 89·5 years]) and follow-up was complete in 94·8%. At implant, dual-chamber systems were implanted in 443 (55·1%), single-chamber ventricular systems in 321 (40·0%), and single-chamber-atrial systems in 39 (4·9%). Observed survival after implantation was significantly worse than expected (P< 0·001). Independent predictors of increased mortality were: age at implant (risk ratio [RR] 1·06; 95% confidence interval [CI] 1·01 to 1·12), VVI pacing mode (RR 1·64; 95% CI 1·34 to 1·93), cardiomyopathy (RR 5·86; 95% CI 4·86 to 6·86), male gender (RR 1·27; 95% CI 1·22 to 1·32) and valvular heart disease (RR 2·01; 95% CI 1·98 to 2·04).
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Conclusions |
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TopAimsMethods and ResultsConclusionsReferences |
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At the end of follow-up, mortality was much higher than expected. In this typical pacemaker population, age at implant and VVI pacing mode were independently associated with increased mortality with accompanying heart disease having the greatest individual impact.Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .
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References |
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