Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up
| Autor: | Alain Le Helloco, Damien Feneon, Raphaël P. Martins, Nathalie Behar, Jean-Claude Daubert, Aurélie Loirat, Christophe Leclercq, Albin Behaghel, Philippe Mabo |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Replacement Population Nonagénaire Comorbidity Kaplan-Meier Estimate Risk Factors Interquartile range Cause of Death Clinical endpoint medicine Humans Nonagenarian Mortality Atrioventricular Block education Device Removal Retrospective Studies Aged 80 and over education.field_of_study Remplacement business.industry Hazard ratio Age Factors Anticoagulants Arrhythmias Cardiac Retrospective cohort study General Medicine Perioperative Confidence interval Surgery Pacemaker Stimulateur cardiaque Platelet aggregation inhibitor Equipment Failure Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Follow-Up Studies |
| Zdroj: | Archives of Cardiovascular Diseases. 108:367-374 |
| ISSN: | 1875-2136 |
| DOI: | 10.1016/j.acvd.2015.01.014 |
| Popis: | Summary Background The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8–10 years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians. Aims To analyse the short- and long-term outcomes after device replacement in nonagenarians. Methods Patients aged ≥ 90 years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality. Results Sixty-two patients were included (mean age 93.3 ± 2.9 years at time of pacemaker replacement). Mean procedure duration was 35.7 ± 17.2 minutes. Mean hospital stay was 2.2 ± 1.1 days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1 months (interquartile range, 11.8–39.8 months). Survival rates were 84.2% (95% confidence interval [CI] 71.8–91.5%) at 1 year, 66.9% (95% CI 51.8–78.2%) at 2 years and 22.7% (95% CI 10.6–37.7%) at 5 years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1–5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0–4.9) were predictors of mortality. Conclusions Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30 months afterwards. |
| Databáze: | OpenAIRE |
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