Long-term survival after permanent pacemaker implantation in young adults: 30 year experience.
The goal of the present study was to determine the etiology of conduction disease and long-term outcome for young adults who undergo permanent pacemaker implantation. Permanent pacing was performed in 232 patients aged 21-50 years, 135 males and 97 females, from 1965 through 1995. One hundred and twenty-six subjects (54%) had evidence of structural heart disease, while idiopathic conduction disease accounted for 46%. About half (54%) of 106 patients with structural heart disease had surgically induced heart block. Pacing mode at primary implantation was single chamber in 65% and dual chamber in 35%. Follow-up ranged from 12-387 months, with a mean of 104-months. At the last follow-up, 133 of 232 patients (57%) were alive, 40 (17%) had died, 30 (13%) were lost to follow-up, 26 (11%) were transferred elsewhere, and 3 (1%) explanted. Patients with sick sinus syndrome had similar outcomes to those with AV block. There was a sharp decline in survival during the first six months; 7.5% of the sample died within the first year following their first pacemaker operation. After the first year, the decline in survival slowed and 70% of the patients could be expected to survive beyond 20 years. The overall survival of young patients without structural heart disease who received a permanent pacemaker was comparable to an age- and sex-matched control population, while patients with structural heart disease performed significantly worse than the control population.
Mayosi
B M
BM
Department of Medicine, Groote Schuur Hospital, Observatory, South Africa.
Little
F
F
Millar
R N
RN
D000328:Adult; D001919:Bradycardia / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000401:mortality / Q000628:therapy; D006331:Heart Diseases / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D015996:Survival Rate