title: Long-term mortality outcomes according to the frequency of right ventricular pacing in veterans.
abstract: Background. Right ventricular pacing (RVP) has been associated with adverse outcomes, including heart failure and death. Minimizing RVP has been proposed as a therapeutic goal for a variety of pacing devices and indications. Objective. Quantify survival according to frequency of RVP in veterans with pacemakers. Methods. We analyzed electrograms from transtelephonic monitoring of veterans implanted with pacemakers between 1995 and 2005 followed by the Eastern Pacemaker Surveillance Center. We compared all cause mortality and time to death between patients with less than 20% and more than 80% RVP. Results. Analysis was limited to the 7198 patients with at least six trans-telephonic monitoring records (mean = 21). Average follow-up was 5.3 years. Average age at pacemaker implant was significantly lower among veterans with <20% RVP (67 years versus 72 years; P < .0001). An equal proportion of deaths during follow-up were noted for each group: 126/565 patients (22%) with <20% RVP and 1113/4968 patients (22%) with >80% RVP. However, average post-implant survival was 4.3 years with <20% RVP versus 4.7 years with >80% RVP (P < .0001). Conclusions. Greater frequency (>80%) of RVP was not associated with higher mortality in this population of veterans. Those veterans utilizing <20% RVP had a shortened adjusted survival rate (P = .0016).
authors.affiliation: School of Medicine, Georgetown University, Washington, DC 20057, USA.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Lampert
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Moore
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Karasik
authors.forename: Brian M
authors.initials: BM
authors.lastname: Lewis
authors.forename: Steven N
authors.initials: SN
authors.lastname: Singh
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
references.citation: J Am Coll Cardiol. 2003 Aug 20;42(4):624-6
references.pmid: 12932591
references.citation: Europace. 2008 Jul;10(7):825-31
references.pmid: 18467299
references.citation: Am Heart J. 1988 Jul;116(1 Pt 1):16-22
references.pmid: 3394616
references.citation: N Engl J Med. 2002 Jun 13;346(24):1854-62
references.pmid: 12063369
references.citation: N Engl J Med. 2001 Apr 5;344(14):1043-51
references.pmid: 11287974
references.citation: N Engl J Med. 2000 May 11;342(19):1385-91
references.pmid: 10805823
references.citation: J Am Coll Cardiol. 2004 Mar 17;43(6):1013-8
references.pmid: 15028360
references.citation: N Engl J Med. 2004 May 20;350(21):2140-50
references.pmid: 15152059
references.citation: Am J Cardiol. 2005 Apr 15;95(8):966-9
references.pmid: 15820164
references.citation: Circulation. 2003 Jun 17;107(23):2932-7
references.pmid: 12782566
references.citation: Heart Rhythm. 2005 Aug;2(8):830-4
references.pmid: 16051118
references.citation: Am J Cardiol. 1992 Nov 15;70(15):1320-5
references.pmid: 1442585
references.citation: Circulation. 1999 Jun 8;99(22):2927-33
references.pmid: 10359738
references.citation: N Engl J Med. 1998 Apr 16;338(16):1097-104
references.pmid: 9545357
references.citation: Lancet. 1997 Oct 25;350(9086):1210-6
references.pmid: 9652562
references.citation: Pacing Clin Electrophysiol. 2006 Jul;29(7):697-705
references.pmid: 16884504
references.citation: JAMA. 2002 Dec 25;288(24):3159-61
references.pmid: 12495397