1
|
Lin HC, Hung MJ, Wang CH, Chen TH, Chen WS, Cheng CW. Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1499. [PMID: 37629789 PMCID: PMC10456785 DOI: 10.3390/medicina59081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06-4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77-6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02-3.43) and dyspnea as the major presenting symptom (1.90, 1.03-3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24-17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.
Collapse
Affiliation(s)
- Hsuan-Ching Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Wei-Siang Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| |
Collapse
|
2
|
Burst Stimulation of the Thoracic Spinal Cord near a Cardiac Pacemaker in an Elderly Patient with Postherpetic Neuralgia: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57040337. [PMID: 33916023 PMCID: PMC8067005 DOI: 10.3390/medicina57040337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022]
Abstract
New developments in spinal cord stimulation (SCS) have improved the treatment of patients with chronic pain. Although the overall safety of modern SCS has been established, there are no published reports regarding safety considerations when implanting a burst-mode spinal cord stimulator in patients with permanent cardiac pacemakers (PCPs). An 80-year-old man with a complete atrioventricular block implanted with a PCP was considered as a candidate for burst-mode SCS due to well-established postherpetic neuralgia (>180 days after rash). Cardiac monitoring during the burst-mode spinal cord stimulator trial and insertion did not indicate any interference. After the insertion of the burst-mode spinal cord stimulator, the patient showed functional improvement and significant pain relief. The safety of traditional tonic-mode SCS in patients with PCP has been previously reported. This is the first case report describing the safe and effective use of burst-mode SCS in a patient with PCP.
Collapse
|
3
|
Smith B, Ashton L. Extreme pacemaker reel syndrome in an elderly patient with cognitive impairment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:353-357. [PMID: 32207647 DOI: 10.12968/bjon.2020.29.6.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Twiddler's syndrome is a rare cause of pacemaker failure, where patient manipulation of the pulse generator results in lead dislodgement or retraction. Variations in manifestation have been identified including reel syndrome, where rotation occurs around the transverse axis resulting in coiling of the leads, and ratchet syndrome where arm movement results in lead displacement. Device manipulation leading to device failure has been documented in up to 1.7% of implants, particularly in patients with large pockets or mental disorders. Such complications have serious consequences, particularly in pacing-dependent patients where loss of capture may result in asystole. This article reviews the case of an 84-year-old patient presenting at 8-month pacemaker follow-up in complete heart block with no evidence of pacemaker function.
Collapse
Affiliation(s)
- Bethany Smith
- Cardiac Physiologist, North Cumbria University Hospital
| | - Lisa Ashton
- Lecturer BSc Healthcare Science (Cardiac Physiology), School of Medicine, University of Leeds
| |
Collapse
|
4
|
Balla C, Malagu' M, Fabbian F, Guarino M, Zaraket F, Brieda A, Smarrazzo V, Ferrari R, Bertini M. Prognosis after pacemaker implantation in extreme elderly. Eur J Intern Med 2019; 65:37-43. [PMID: 31097259 DOI: 10.1016/j.ejim.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 01/23/2023]
Abstract
AIMS Significant comorbidities may limit the potential benefit of pacemaker (PM) implantation in extreme elderly. A short-term mortality risk prediction score, able to identify high-risk patients, may be a useful tool in this population. METHODS AND RESULTS We retrospectively analyzed 538 patients aged >80 years at the time of implant who underwent PM implantation. Kaplan-Meier survival and multivariable Cox regression analyses were performed to identify patient, procedural or complication variables predictive of death. The ACP (Aging in Cardiac Pacing) Score was constructed by assigning weighted values to the variables identified by hazard ratios, combined into an additive mortality risk score equation. One, two and three-year overall mortality rate was 11%, 21% and 32% respectively. Renal failure (HR 1.63; CI 1.15-2.31; p = .006), active neoplasia (HR 1.78; CI 1.27-2.51; p = .008), connective tissue disorder (3.07; CI 1.34-7.08; p = .048), cerebrovascular disease (HR 1.75; CI 1.25-2.46; p = .001) and the use of a single lead device (HR 2.27; CI 1.6-3.24; p < .001) were independently associated with worse survival. The ACP Score showed discrete predictive ability (AUC 0,6792 CI 0,63-0,73). Kaplan-Meier survival curves comparing low vs high ACP Scores demonstrated that low ACP scores were associated with reduced mortality rates (p < .001). CONCLUSIONS Significant comorbidities were associated with worse survival after PM implantation in extreme elderly. The ACP Score is a novel tool that may help to identify patients with high mortality risk after device implantation.
Collapse
Affiliation(s)
- Cristina Balla
- Cardiovascular Center, University of Ferrara, Ferrara, Italy.
| | - Michele Malagu'
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
| | | | - Matteo Guarino
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
| | - Fatima Zaraket
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
| | | | | | - Roberto Ferrari
- Cardiovascular Center, University of Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care&Research, Italy
| | - Matteo Bertini
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
| |
Collapse
|
5
|
Cheng CW, Wang CH, Chen WS, Wang CC, Cherng WJ. Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older. Aging Clin Exp Res 2019; 31:1001-1009. [PMID: 30259339 PMCID: PMC6589145 DOI: 10.1007/s40520-018-1044-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
Background There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. Aims We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. Methods and results From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2 (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m2 (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. Conclusions Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older.
Collapse
Affiliation(s)
- Chi-Wen Cheng
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC.
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Wei-Siang Chen
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, ROC
| | - Chun-Chieh Wang
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Wen-Jin Cherng
- Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| |
Collapse
|
6
|
Terekhov D, Agapov V, Kulikov K, Zadorozhnaya S, Samitin V, Maslyakov V. Pacemaker Implantation in Elderly Patients: Safety of Various Regimens of Anticoagulant Therapy. J Atr Fibrillation 2017; 9:1467. [PMID: 29250265 PMCID: PMC5673381 DOI: 10.4022/jafib.1467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/19/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study incidence of hemorrhagic complications after pacemaker implantation in elderly patients receiving antithrombotic therapy with warfarin or uninterrupted dabigatran. METHODS 126 patients aged 83 [82; 85] years who receive continuous antithrombotic therapy after pacemaker implantation, were enrolled in the study. Adverse event data were collected during hospitalization and further 12 weeks. RESULTS 95 subjects (75.4%) from general number of enrolled patients received elective anticoagulant warfarin therapy and 31 subjects (24.6%) were treated with dabigatran. All patients of dabigatran group received 220 mg/day skipping the last dose before a surgery and resumed the drug intake in 36-48 hours after it. Patients of warfarin group underwent surgery if INR was NMT 3; they didn't stop taking the drug for the duration of operation.No statistically significant differences of hematoma incidence were detected in dabigatran (incidence is 0.065, 95%CI (-0.02-0.15)) and warfarin (incidence is 0.05, 95%CI (0.006-0.01)) groups, p(Fisher)= 0.55. Three cases of nonfatal gastrointestinal bleeding (warfarin group) and 1 similar event in dabigatran group were detected during a follow-up (12 [6; 20] weeks): RR= 0.98 (warfarin group), p(Fisher)=0.68. No statistically significant difference of age, sex composition, history of IHD and diabetes was detected between groups by comparison of individual characteristics of patients whose surgeries were complicated/non-complicated by hematoma formation. Upon that, hematoma formation rate was significantly higher in patients with adjunctive pacemaker muscular fixation: 71.4% vs 31.9% (patients without hematomas), p(Fisher)= 0.045. CONCLUSION Incidence of hematoma formation after pacemaker implantation in patients > 75 years receiving warfarin or dabigatran, is the same as in general population of patients treated with anticoagulants. Adjunctive pacemaker muscular fixation is a significant risk factor of hematoma formation.
Collapse
Affiliation(s)
- Denis Terekhov
- Saratov Regional Cardiac Centre; Krymskaya ulitsa, 15, Saratov, 410039, Russian Federation
| | - Valeriy Agapov
- Saratov Regional Cardiac Centre; Krymskaya ulitsa, 15, Saratov, 410039, Russian Federation
| | - Kirill Kulikov
- Saratov Regional Cardiac Centre; Krymskaya ulitsa, 15, Saratov, 410039, Russian Federation
| | - Svetlana Zadorozhnaya
- Saratov Regional Cardiac Centre; Krymskaya ulitsa, 15, Saratov, 410039, Russian Federation
| | - Vasiliy Samitin
- Saratov Regional Cardiac Centre; Krymskaya ulitsa, 15, Saratov, 410039, Russian Federation
| | - Vladimir Maslyakov
- Saratov Medical Institute “REAVIZ”; ulitsa Verkhny Rynok, 10, Saratov, 410004, Russian Federation
| |
Collapse
|
7
|
Life expectancy after implantation of a first cardiac permanent pacemaker (1995–2008): A population-based study. Int J Cardiol 2015; 190:42-6. [DOI: 10.1016/j.ijcard.2015.04.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/14/2015] [Indexed: 11/15/2022]
|
8
|
Jones MA, Wong KCK, Qureshi N, Rajappan K, Bashir Y, Betts TR. A pacemaker magnet check alone is sufficient for the majority of patients postpacemaker implant. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1619-23. [PMID: 25195808 DOI: 10.1111/pace.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients postpacemaker implant can undergo a full assessment by pacing system programmer (PSP) or a magnet check. The former takes longer, but provides more detailed information; a magnet-mode assessment is faster, but provides only capture data in an asynchronous pacing mode. A magnet-mode assessment alone may be sufficient in most cases, and current clinical practice varies considerably. METHODS A retrospective single-center assessment of all pacemaker implants receiving PSP and magnet checks between September 2009 and April 2010. Patient records were reviewed. The results of PSP and magnet checks and any subsequent device-related management were noted. RESULTS A total of 168 patients underwent pacemaker implantation, magnet-mode assessment, and then PSP interrogation during this period. Magnet-mode assessment revealed a problem in only one patient-failure of atrial capture, leading to subsequent atrial lead repositioning. None of the remaining 167 patients have a serious problem at PSP interrogation; six had minor issues at PSP check, none of which required repeat surgical intervention. CONCLUSIONS The magnet-mode test only provides information on lead capture in an asynchronous pacing mode, which is the most essential data postoperatively. Our study has suggested that a magnet-mode assessment without PSP interrogation may be sufficient in the immediate postimplant assessment of these patients. Routine postimplant PSP interrogation is time consuming, labor intensive, and adds only minimal additional benefit to the safe management of these patients above and beyond a magnet check, coupled with informed assessment of the associated electrocardiogram/rhythm strip, clinical examination, and chest x-ray.
Collapse
Affiliation(s)
- Michael A Jones
- Cardiology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, UK
| | | | | | | | | | | |
Collapse
|
9
|
Antonelli D, Freedberg NA, Bushari LI, Feldman A, Turgeman Y. Permanent pacing in nonagenarians over 20-year period. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:48-53. [PMID: 25196677 DOI: 10.1111/pace.12499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/10/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Life expectancy increases progressively and nonagenarians are a growing population. We report trends in pacing and long-term outcome in nonagenarians over a 20-year period in a single center compared with those of younger patients. METHODS We retrospectively reviewed all the patients who underwent their first pacemaker implantation from January 1, 1991 to December 31, 2010 and were followed through December 31, 2013. RESULTS During the study period, 1,009 patients underwent first pacemaker implantation: 45 patients were older than 90 years (mean age 92.5 ± 2.6) (4.5%); 21 were men. Battery replacement was performed in four patients in whom first implant was made at age ≥ 90 years (8.9%) and in 231 patients aged <90 (24%; P < 0.01). Syncope was the most common symptom leading to pacing, followed by dizziness and fatigue in all age groups; no significant difference of symptoms was found between patient age groups. In patients aged ≥ 90 atrioventricular block and atrial fibrillation with slow ventricular response were more frequent, while sick sinus syndrome and carotid sinus hypersensitivity were less frequent than in younger patients. Ventricular chamber pacemakers were implanted with significant growing frequency, according to the older patients' age. Neither the indication for pacemaker implantation nor pacing mode influenced survival. CONCLUSIONS Nonagenarians are a growing population. Symptoms leading to pacing in patients aged ≥ 90 were similar to those of younger patients, but different frequency was found in the electrocardiographic indications. Ventricular chamber pacemakers were significantly more implanted than dual-chamber pacemakers but without negative survival influence.
Collapse
Affiliation(s)
- Dante Antonelli
- Department of Cardiology, Ha Emek Medical Center, Afula, Israel
| | | | | | | | | |
Collapse
|
10
|
Mortality in patients on renal replacement therapy and permanent cardiac pacemakers. Int J Nephrol 2014; 2014:284172. [PMID: 24977040 PMCID: PMC4058238 DOI: 10.1155/2014/284172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
End stage renal disease is a relatively frequent disease with high mortality due to cardiac causes. Permanent pacemaker (PM) implantation rates are also very common; thus combination of both conditions is not unusual. We hypothesized that patients with chronic kidney disease with a PM would have significantly higher mortality rates compared with end stage renal disease patients without PM. Our objectives were to analyze mortality of patients on renal replacement therapy with PM. 2778 patients were on renal replacement therapy (RRT) and 110 had a PM implanted during the study period. To reduce the confounding effects of covariates, a propensity-matched score was performed. 52 PM patients and 208 non-PM matched patients were compared. 41% of the PM were implanted before entering the RRT program and 59% while on RRT. Mortality was higher in the PM group. Cardiovascular disease and infections were the most frequent causes of death. Propensity analysis showed no differences in long-term mortality between groups. We concluded that in patients on RRT and PM mortality rates are higher. Survival curves did not differ from a RRT propensity-matched group. We concluded that the presence of a PM is not an independent mortality risk factor in RRT patients.
Collapse
|
11
|
Chao TF, Liu CJ, Tuan TC, Liao JN, Lin YJ, Chen TJ, Kong CW, Chen SA. Long-term prognosis of patients older than ninety years after permanent pacemaker implantation: does the procedure save the patients? Can J Cardiol 2014; 30:1196-201. [PMID: 25262861 DOI: 10.1016/j.cjca.2014.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The implantation of a permanent pacemaker (PPM) is life-saving for patients with life-threatening bradycardia. However, the effectiveness and prognosis of PPM implantations for extremely old patients (≥ 90 years old) have not been investigated. METHODS From 2001-2012, a total of 108 patients older than 90 years were identified from 2630 consecutive patients receiving PPM implantations in our hospital as the study group. For each study patient, 4 age-, sex-, and comorbidity-matched subjects who did not have the diagnoses of bradyarrhythmias indicated for PPM implantations were selected from the "Taiwan National Health Research Database" to constitute the control group (n = 432). The study end point was all-cause mortality. RESULTS The median age of the study population was 91 (interquartile range, 90-93) years. Among the PPM group, 45 patients died during the follow-up with an annual mortality rate of 18.7%. The risk of mortality did not differ significantly between the study and control groups with a hazard ratio of 1.020 (95% confidence interval, 0.724-1.437; P = 0.912) after the adjustment for age and sex. Procedure-related complications occurred in 7.4% of the patients receiving PPM implants, and pocket hematoma was the most common. The preimplantation history of heart failure and cerebrovascular accident, rather than age, were significant predictors of mortality among PPM recipients. CONCLUSIONS Nonagenarians with severe bradyarrhythmias could retain the same life expectancies as those without bradyarrhythmias through PPM implantations. Extremely old age (≥90 years) should not be a barrier for PPM implants when indications are present.
Collapse
Affiliation(s)
- Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Woon Kong
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
12
|
Aging might increase the incidence of infection from permanent pacemaker implantation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2013:943416. [PMID: 24379903 PMCID: PMC3863541 DOI: 10.1155/2013/943416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/24/2013] [Indexed: 11/18/2022]
Abstract
Aim. The elderly are the major population receiving the implantation of a permanent pacemaker (PPM). Infection is a devastating complication. The present study is to verify the relationship between age and PPM implantation infection. Methods. All patients (162 adult and 292 elder patients) received the implantation of PPM. Subcutaneous tissue samples solution was collected in three time points, the first sample was got at skin incision, and the second sample was got when the PPM had been implanted. And the third sample was got after 0.9% NaCl quick rinse. And the tissue solutions were cultured. If culture results are positive, it is considered as evidence of the presence of bacteria in pocket in operation of PPM implantation. Results. The data demonstrated that compared with that in the adult patients, subcutaneous bacterial survival rate was higher significantly in the elderly. Staphylococcus epidermidis is the major bacterial strain. The rinse decreased subcutaneous bacterial survival rates in the adult group. Conclusion. With the age increasing, PPM implantation might be easier to result in infection. Simple rinse can prevent implantation infection significantly. However, age alleviated the protective effects of rinse. Therefore, we should pay more attention to post implantation infection in the elderly.
Collapse
|
13
|
Gur DO, Gur O. Pacemaker extrusion: a rare clinical problem mainly in elderly adults. J Am Geriatr Soc 2013; 61:1844-5. [PMID: 24117313 DOI: 10.1111/jgs.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Ozcan KS, Osmonov D, Altay S, Dönmez C, Yıldırım E, Türkkan C, Güngör B, Ekmekçi A, Alper AT, Gürkan K, Erdinler I. Pacemaker implantation complication rates in elderly and young patients. Clin Interv Aging 2013; 8:1051-4. [PMID: 23966776 PMCID: PMC3743522 DOI: 10.2147/cia.s47121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation. Methods We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old) and elderly (≥70 years old) patients. Results Among 574 patients with a permanent pacemaker, 259 patients (45.1%) were below and 315 patients (54.9%) were above or at 70 years of age. There were 240 (92.7%) and 19 (7.3%) dual-chamber pacemaker (DDD) and single-chamber pacemaker (VVI) implanted patients in the younger group, and 291 (76.8%) and 73 (23.2%) DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1%) out of 259 young patients and 24 (7.6%) out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005). Conclusion A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.
Collapse
Affiliation(s)
- Kazım Serhan Ozcan
- Department of Cardiology, siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Incidence and predictors of short- and long-term complications in pacemaker therapy: The FOLLOWPACE study. Heart Rhythm 2012; 9:728-35. [DOI: 10.1016/j.hrthm.2011.12.014] [Citation(s) in RCA: 337] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Indexed: 12/22/2022]
|
16
|
Udo EO, van Hemel NM, Zuithoff NPA, Kelder JC, Crommentuijn HA, Koopman-Verhagen AM, Voskuil T, Doevendans PAFM, Moons KGM. Long-term outcome of cardiac pacing in octogenarians and nonagenarians. Europace 2011; 14:502-8. [DOI: 10.1093/europace/eur329] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Modi S, Krahn A, Yee R. Current concepts in pacing 2010-2011: the right and wrong way to pace. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:370-84. [PMID: 21710197 DOI: 10.1007/s11936-011-0137-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT Over five decades have passed since the first permanent cardiac pacemakers were introduced into clinical medicine. Evolving technology and falling costs have demanded adaptation to clinical practice and implantation trends and, with the advent of evidenced-based medicine, the specific roles and benefits of individual pacemaker technologies have never been so carefully scrutinized. Pacing mode choice continues to be a subject of great controversy, and there are great regional variations in practice. We believe that single chamber atrial pacing use (AAI/R) has become an anachronism that should generally be abandoned (obviously with rare exceptional cases) and be replaced by dual chamber pacemakers (DDD/R) equipped with modern pacing algorithms that minimize patient exposure to ventricular pacing. Also, in patients with atrioventricular (AV) block, randomized clinical trials have failed to show improvement in clinically relevant outcomes such as mortality, stroke, and heart failure, particularly in the elderly, which has led some to advocate that DDD/R devices should never be offered to elderly AV block patients. However, we believe that the elderly, like the young, come in many "shapes and sizes" and individualized medicine compels us to consider each pacemaker candidate as unique. Implanting DDD/R devices in chronologically older, yet physiologically younger, patients is justifiable and good medical practice. Where right ventricular (RV) pacing is necessary and unavoidable, physicians should consider routinely placing RV leads on the RV mid- or outflow tract septum because these location are as good, if not better, for patients than the current practice of RV apical lead placement. In patients with AV block and asymptomatic yet moderate to severely depressed left ventricular systolic function, primary cardiac resynchronization therapy (CRT) should be strongly considered. Compelling clinical trial evidence does not yet exist to indicate that CRT should be the standard of care in patients with AV block and intact left ventricular systolic function. Right ventricular septal lead placement remains a reasonable option.
Collapse
Affiliation(s)
- Simon Modi
- Arrhythmia Service, London Health Sciences Centre, London, ON, Canada,
| | | | | |
Collapse
|
18
|
Steinbach M, Douchet MP, Bakouboula B, Bronner F, Chauvin M. Outcome of patients aged over 75 years who received a pacemaker to treat sinus node dysfunction. Arch Cardiovasc Dis 2011; 104:89-96. [DOI: 10.1016/j.acvd.2010.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/25/2010] [Accepted: 11/26/2010] [Indexed: 11/25/2022]
|
19
|
Guidoin R, Douville Y, Clavel MA, Zhang Z, Nutley M, Pîbarot P, Dionne G. The marvel of percutaneous cardiovascular devices in the elderly. Ann N Y Acad Sci 2010; 1197:188-99. [DOI: 10.1111/j.1749-6632.2010.05517.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Kirkpatrick JN, Papini C, Baman TS, Kota K, Khota K, Eagle KA, Verdino RJ, Caplan AL. Reuse of pacemakers and defibrillators in developing countries: logistical, legal, and ethical barriers and solutions. Heart Rhythm 2010; 7:1623-7. [PMID: 20430113 DOI: 10.1016/j.hrthm.2010.04.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 04/23/2010] [Indexed: 12/30/2022]
Abstract
In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse.
Collapse
Affiliation(s)
- James N Kirkpatrick
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
OUALI SANA, NEFFETI ELYES, GHOUL KARIMA, HAMMAS SAMI, KACEM SLIM, GRIBAA RIM, REMEDI FAHMI, BOUGHZELA ESSIA. DDD versus VVIR Pacing in Patients, Ages 70 and Over, with Complete Heart Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:583-9. [DOI: 10.1111/j.1540-8159.2009.02636.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
22
|
Marschall J, Hopkins-Broyles D, Jones M, Fraser VJ, Warren DK. Case-control study of surgical site infections associated with pacemakers and implantable cardioverter-defibrillators. Infect Control Hosp Epidemiol 2007; 28:1299-304. [PMID: 17926282 DOI: 10.1086/520744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/05/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. DESIGN Unmatched 1 : 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. SETTING The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. PATIENTS Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. RESULTS A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P=.006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P=.02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P=.003). CONCLUSIONS Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.
Collapse
Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | | | | |
Collapse
|
23
|
Abstract
Sinus node disease and atrioventricular block are common etiologies of symptomatic bradyarrhythmias in the elderly and remain the leading indications for permanent pacemaker implantation. In fact, the vast majority (>80%) of all pacemakers are implanted in the elderly. Whereas indications of pacemaker therapy have been largely unchanged over the past several years, several questions, such as differences in pacemaker mode selection, remained unanswered. Recent large, randomized, multicenter trials have evaluated the benefits of pacemaker therapy in sinus node dysfunction and acquired atrioventricular block and have provided us with further insights into the difference between atrial- and ventricular-based pacing in these syndromes. Further evaluation of the most appropriate pacing mode in the elderly as well as the outcome of pacing in the elderly are addressed in this review.
Collapse
Affiliation(s)
- Karoly Kaszala
- Cardiac Electrophysiology Program, Division of Cardiology, McGuire VA Medical Center, Richmond, VA, USA
| | | | | |
Collapse
|
24
|
|