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Europace 2005 7(6):598-603; doi:10.1016/j.eupc.2005.07.003
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

SHORT SERIES REPORT

Twins with implanted pacemakers: Is there an increased mortality risk for the co-twin? A follow-up study based on the Danish Twin Registry and the Danish Pacemaker Register

Claus Tveskova,*, Axel Skyttheb, Per Arnsboa, James W. Vaupelb, Mogens Møllera and Kaare Christensenb

aThe Danish Pacemaker Register, Department of Cardiology, Odense University Hospital DK-5000 Odense C, Denmark; bThe Danish Twin Register, Institute of Public Health, Epidemiology, University of Southern Denmark DK-5000 Odense C, Denmark

Abstract

BACKGROUND: The main indications for implanting a cardiac pacemaker are either acquired atrio-ventricular block (AVB) or sick sinus syndrome (SSS). In general, the exact aetiology of these conditions is unknown. Genetic factors may play a role. Untreated AVB is associated with increased mortality but SSS seems to have a good prognosis.

The present study was designed to assess whether first-degree relatives of these patients have an increased mortality risk.

METHODS: We investigated the survival pattern of the co-twins of twins who have had a cardiac pacemaker implanted, by linking two nationwide registries in Denmark: the Danish Pacemaker Register and the Danish Twin Registry.

For each "pacemaker-twin" four control-twins matched with respect to age, sex, and zygosity were selected among the twins who were alive at the time of the pacemaker implantation.

A total of 159 twins with a pacemaker treated bradycardia of unknown aetiology were identified of which 73 had AVB and 64 had SSS. A total of 622 matched control-twins could be identified.

The survival from age six of the co-twins of the "pacemaker-twins" was compared with that of the co-twins of the control-twins. The follow-up period ended January 1st, 2000.

FINDINGS: The survival curves for the co-twins of the "pacemaker-twins" were virtually identical to those of the co-twins of the control-twins. This finding was consistent for both AVB and SSS and for monozygotic as well as dizygotic twins.

CONCLUSION: No increased mortality risk could be demonstrated for first-degree relatives – including monozygotic twins – of patients with a cardiac pacemaker implanted due to either acquired AVB or SSS.

Key Words: pacemaker, atrio-ventricular block, sick sinus syndrome, twins

*Corresponding author. Department of Medicine, Svendborg Hospital, DK-5700 Svendborg, Denmark. Tel.: +45 63202215; fax: +45 63202229. E-mail address: tveskov{at}dadlnet.dk


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