title: Permanent pacing in nonagenarians over 20-year period.
abstract: BACKGROUND
  Life expectancy increases progressively and nonagenarians are a growing population. We report trends in pacing and long-term outcome in nonagenarians over a 20-year period in a single center compared with those of younger patients.
  
  
  METHODS
  We retrospectively reviewed all the patients who underwent their first pacemaker implantation from January 1, 1991 to December 31, 2010 and were followed through December 31, 2013.
  
  
  RESULTS
  During the study period, 1,009 patients underwent first pacemaker implantation: 45 patients were older than 90 years (mean age 92.5 ± 2.6) (4.5%); 21 were men. Battery replacement was performed in four patients in whom first implant was made at age ≥ 90 years (8.9%) and in 231 patients aged <90 (24%; P < 0.01). Syncope was the most common symptom leading to pacing, followed by dizziness and fatigue in all age groups; no significant difference of symptoms was found between patient age groups. In patients aged ≥ 90 atrioventricular block and atrial fibrillation with slow ventricular response were more frequent, while sick sinus syndrome and carotid sinus hypersensitivity were less frequent than in younger patients. Ventricular chamber pacemakers were implanted with significant growing frequency, according to the older patients' age. Neither the indication for pacemaker implantation nor pacing mode influenced survival.
  
  
  CONCLUSIONS
  Nonagenarians are a growing population. Symptoms leading to pacing in patients aged ≥ 90 were similar to those of younger patients, but different frequency was found in the electrocardiographic indications. Ventricular chamber pacemakers were significantly more implanted than dual-chamber pacemakers but without negative survival influence.
authors.affiliation: Department of Cardiology, Ha Emek Medical Center, Afula, Israel.
authors.forename: Dante
authors.initials: D
authors.lastname: Antonelli
authors.forename: Nahum A
authors.initials: NA
authors.lastname: Freedberg
authors.forename: Limor I
authors.initials: LI
authors.lastname: Bushari
authors.forename: Alexander
authors.initials: A
authors.lastname: Feldman
authors.forename: Yoav
authors.initials: Y
authors.lastname: Turgeman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D013997:Time Factors
keywords: follow-up; nonagenarians; pacing; very elderly patients