Krzemien-Wolska K, et al. - The researchers aimed to evaluate the risk factors for death among patients with implanted pacemakers >80 years of age in a 4-year follow-up. In long-term follow-up, DDD mode pacing seemed to serve as a factor which decreased mortality among patients aged >80 years. For the female patients, the potentially poorer prognosis in this group could result from a combination of the dominant VVI pacing mode, potential propagation of atrial fibrillation, a low proportion of antithrombotic therapy, and sex-related predispositions to thromboembolic complications.

Methods

• The researchers enrolled 140 consecutive patients (79 women) aged 84.48 ± 3.65 years with single- or dual-chamber pacemakers implanted >80 years of age because of symptomatic bradycardia.
• They included demographic, echocardiographic, and laboratory parameters, pharmacotherapy, and factors related to the implanted device (indications, pacemaker type, and the implantation position of the tip of the right ventricular lead), in univariate and multivariate Cox regression analyses.
• Death for any reason was the endpoint in a 4-year follow-up.

Results

• In this study, 68 patients (48.6%) died during follow-up.
• Despite 20% of the indications for implantation included atrial fibrillation with a slow ventricular response, 60.8% of the patients received a single-chamber system (VVI/VVIR).
• The multivariate Cox regression analysis demonstrated both a favourable prognostic significance of DDD pacing system implantation (HR = 0.507; 95% CI: 0.294-0.876) and coexisting hypertension (HR = 0.520; 95% CI: 0.299-0.902) in the whole group.
• Fasting glycaemia (HR = 1.180; 95% CI: 1.038-1.342) and, potentially, female sex (HR = 1.672; 95% CI: 0.988-2.830; p=0.056) were the risk factors.
• A more favourable prognosis was associated with the use of angiotensin-converting enzyme inhibitors (HR = 0.435; 95% CI: 0.202-0.933) and DDD pacemaker implantation (HR = 0.381; 95% CI: 0.180-0.806), in the female subgroup.
• A more favourable prognosis was related to concerned patients with coexisting hypertension (HR = 0.349; 95% CI: 0.079-0.689), in the male subgroup.