title: Outcome of patients aged over 75 years who received a pacemaker to treat sinus node dysfunction.
abstract: BACKGROUND
  The prognosis for patients aged over 75 years who receive a pacemaker in the context of sinus node dysfunction is unclear.
  
  
  OBJECTIVE
  We sought to evaluate the incidences of atrial fibrillation, heart failure and death in such patients, and the role of the pacing mode in their prognosis.
  
  
  METHODS
  This was a retrospective study of 102 patients aged over 75 years (mean 82.2 ± 4.4 years) who received a pacemaker in the context of sinus node dysfunction.
  
  
  RESULTS
  During the follow-up period (mean 806 days), 36 patients (35.3%) experienced heart failure, 47 patients (46.1%) had an episode of paroxysmal atrial fibrillation, 19 patients (18.6%) progressed to chronic atrial fibrillation and 29 (28.4%) died, the fatal event being sudden death or of cardiac origin in almost half of these patients (44.8%). Patients assigned to dual-chamber minimal ventricular pacing showed significantly lower rates of heart failure episodes (P=0.023) and all-cause mortality (P<0.001) than those assigned to conventional dual-chamber pacing. In contrast, the two groups did not differ with regard to either paroxysmal or chronic atrial fibrillation.
  
  
  CONCLUSIONS
  In patients aged over 75 years, the use of dual-chamber pacemakers incorporating an algorithm minimizing ventricular pacing for sinus node dysfunction seems to decrease the number of heart failure episodes and mortality. On the basis of this finding, the implantation of such devices seems justifiable, even in this age group.
authors.affiliation: Department of cardiology, centre hospitalier de Haguenau, 64, avenue du Pr Leriche, 67504 Haguenau cedex, France. mathieu.steinbach@ch-haguenau.fr
authors.forename: Mathieu
authors.initials: M
authors.lastname: Steinbach
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Douchet
authors.forename: Babe
authors.initials: B
authors.lastname: Bakouboula
authors.forename: François
authors.initials: F
authors.lastname: Bronner
authors.forename: Michel
authors.initials: M
authors.lastname: Chauvin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome