title: Long-term survival after pacemaker implantation for heart block in patients > or = 65 years.
abstract: Permanent pacing can prevent recurrent symptoms and reduce mortality in elderly patients with symptomatic high-degree atrioventricular (AV) block. However, long-term survival with respect to comparable control subjects has not been well defined. In our study, relative long-term survival and prognostic predictors after permanent pacemaker implantation for symptomatic high-degree AV block were assessed among all residents of Olmsted County, Minnesota, who were > or = 65 years old. Of the 154 patients, 77 were men and 77 were women (mean age 80 +/- 7 years). Follow-up was 0.1 to 19.8 years (mean 4.2 +/- 2.8). Sixty-nine patients had isolated AV block and 85 had coexisting heart disease. Observed survival at 1, 3, 5, and 10 years was 85%, 68%, 52%, 21%, and 72%, 50%, 31%, 11% for patients with isolated AV block and patients with coexisting heart disease, respectively (p = 0.006). Observed survival in patients 65 to 79 years old with isolated AV block was comparable to age- and sex-matched cohorts (p = 0.53), but in patients aged > or = 80 years, it was less than that for control subjects (p = 0.014). In patients with coexisting heart disease, observed survival was less than that for control subjects in patients 65 to 79 years old (p < 0.001) and > or = 80 years (p < 0.001). Multivariate analysis identified congestive heart failure, chronic obstructive pulmonary disease, age, syncope, insulin-dependent diabetes mellitus, and male gender as independent predictors of increased mortality.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: W K
authors.initials: WK
authors.lastname: Shen
authors.forename: S C
authors.initials: SC
authors.lastname: Hammill
authors.forename: D L
authors.initials: DL
authors.lastname: Hayes
authors.forename: D L
authors.initials: DL
authors.lastname: Packer
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: D J
authors.initials: DJ
authors.lastname: Ballard
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001283:Atrioventricular Node / Q000503:physiopathology*; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006327:Heart Block / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors