title: Long-term follow-up of older patients with Mobitz type I second degree atrioventricular block.
abstract: OBJECTIVE
  To examine the long-term survival of older patients with Mobitz I second degree atrioventricular (AV) block.
  
  
  METHODS
  Retrospective cohort study. Propensity score adjustment for requiring a cardiac implantable electronic device (CIED) was performed. Multivariable Cox regression analysis was used.
  
  
  METHODS
  Tertiary care referral centre.
  
  
  METHODS
  We examined 299 older patients (age >45 years) with Mobitz I second degree AV block on ECG at the Minneapolis Veterans Affairs Medical Center from 1992 to 2010.
  
  
  METHODS
  Survival.
  
  
  RESULTS
  The average age of patients was 75±9 years; 99% were male; 59% had coronary heart disease; 44% had heart failure. 141 (47%) patients required CIED, of which 17 were implantable cardioverter-defibrillators (ICDs). CIEDs were implanted a median of 110 days after the ECG for symptomatic bradycardia, high-degree AV block or prevention of sudden cardiac death. Patients with CIED had greater cardiac co-morbidity than those without CIED. After a median 3.3 years of follow-up (range 3 days to 19 years), 190 (64%) patients died. Patients with CIED had longer survival than those without CIED (p=0.001). In propensity-adjusted multivariable Cox regression analysis, CIED implantation was associated with a 46% reduction in mortality (HR 0.54, 95% CI 0.35 to 0.82; p=0.004). Excluding 17 patients with ICDs did not alter the results.
  
  
  CONCLUSIONS
  In this retrospective cohort study of older male patients with Mobitz I AV block on ECG, CIED implantation was associated with longer survival.
authors.affiliation: Division of Cardiology, Veterans Administration Medical Center, Section of Cardiology (111 C), One Veterans Drive, Minneapolis, MN 55417, USA.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Coumbe
authors.forename: Niyada
authors.initials: N
authors.lastname: Naksuk
authors.forename: Marc C
authors.initials: MC
authors.lastname: Newell
authors.forename: Porur E
authors.initials: PE
authors.lastname: Somasundaram
authors.forename: David G
authors.initials: DG
authors.lastname: Benditt
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome