title: Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up.
abstract: BACKGROUND
  The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8-10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians.
  
  
  OBJECTIVE
  To analyse the short- and long-term outcomes after device replacement in nonagenarians.
  
  
  METHODS
  Patients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality.
  
  
  RESULTS
  Sixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8-39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8-91.5%) at 1year, 66.9% (95% CI 51.8-78.2%) at 2years and 22.7% (95% CI 10.6-37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1-5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0-4.9) were predictors of mortality.
  
  
  CONCLUSIONS
  Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards.
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Loirat
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Fénéon
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Albin
authors.initials: A
authors.lastname: Behaghel
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Behar
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Helloco
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: CHU de Rennes, service de cardiologie et maladies vasculaires, 35000 Rennes, France; Université de Rennes 1, CIC-IT 804, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France. Electronic address: raphael.martins@chu-rennes.fr.
authors.forename: Raphaël P
authors.initials: RP
authors.lastname: Martins
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D054537:Atrioventricular Block / Q000628:therapy; D002423:Cause of Death; D015897:Comorbidity; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Nonagenarian; Nonagénaire; Pacemaker; Remplacement; Replacement; Stimulateur cardiaque