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Prognosis of the Bradycardia Pacemaker Recipient Assessed at First Implantation: A Nationwide Cohort Study
Study Questions:
What are the long-term prognosis and pre-implantation determinants of prognosis of bradycardia pacemaker (PM) recipients?
Methods:
This was a prospective cohort study in 23 Dutch pacemaker centers. Pre-implantation characteristics of 1,517 patients receiving a first bradycardia PM between 2003–2007 were studied in relation to survival. Patients were followed up during routine clinical practice. The main outcome measures were cause and time to death. Survival after PM implantation was estimated using the Kaplan–Meier method. Cox regression analysis was performed relating each candidate predictor with each outcome separately.
Results:
At the end of a mean follow-up of 5.8 (standard deviation 1.1) years, 512 patients (33%) died, mostly of noncardiac cause (67%). There were two PM-related deaths. Survival rates were 93%, 81%, 69%, and 61% after 1, 3, 5, and 7 years, respectively. PM recipients without concomitant cardiovascular disease at implantation showed survival rates comparable to age- and sex-matched controls. Predictors at time of implantation associated with cardiac mortality were: age, coronary artery disease (CAD), diabetes, heart failure, valve disease, and the indication for PM implantation. Predictors for all-cause mortality were: male gender, age, body mass index, CAD, cardiac surgery, diabetes, heart failure, and maintained atrioventricular synchrony.
Conclusions:
The authors concluded that a pre-implantation history of heart failure, CAD, and diabetes are the most important predictors for worse prognosis in PM recipients.
Perspective:
This prospective multicenter study of unselected bradycardia PM recipients reported that PM recipients without underlying heart disease have a prognosis similar to that of the general population. The study identified several predictors at the time of implantation to be independently associated with a worse prognosis, the most important being a history of heart failure, CAD, and diabetes. These observations suggest that the prognosis of contemporary PM recipients is mainly determined by cardiovascular comorbidity, and a pure bradycardia indication for pacing does not appear to influence survival.
Keywords: Prognosis, Coronary Artery Disease, Heart Failure, Pacemaker, Artificial, Bradycardia
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