Adherence to the current guidelines for bradycardic pacing in the octogenarian and nonagenarian populations.
OBJECTIVE
A significant proportion of single-chamber ventricular pacemakers are implanted in octogenarian and nonagenarian patients. We aimed to assess whether the current pacing guideline is adhered for these populations.


METHODS
We retrospectively identified patients ≥80 years of age, who received their first pacemaker from July 2010 to June 2013.


RESULTS
A total of 356 patients were identified. Mean age was 86.1 years and 82.6 years for single and dual-chamber pacemakers respectively (p<0.05). Total procedure-related complications occurred in 9.5% and were comparable between both groups (p=0.08). At the time of implantation, 185 patients who received single-chamber pacemaker were in sinus rhythm (52%). They were older (86.2±4.3 vs 82.6±2.9, p<0.05), more likely to have ischaemic and valvular heart disease (68 vs 27, p= 0.02 and 22 vs 13, p=0.01, respectively), and cognitive impairment (34 vs 0, p= 0.001). They were also more likely to be discharged to a residential care facility (17 vs 1, p<0.01).


CONCLUSIONS
The utility of dual-chamber pacemaker in this age group remains below expectation and did not comply with current cardiac pacing guidelines. The presence of older age, multiple co-morbidities, cognitive impairment and residential care on discharge likely influenced the type of device implanted.
General Medicine & Health of Older People Services, North Shore Hospital, Auckland.
Vivienne
V
Kim
Green Lane Cardiovascular Services, Auckland City Hospital, Auckland.
James
J
Pemberton
Green Lane Cardiovascular Services, Auckland City Hospital, Auckland.
Fiona
F
Riddell
Green Lane Cardiovascular Services, Auckland City Hospital, Auckland.
Khang-Li
KL
Looi
D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009520:New Zealand; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies