title: Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction.
abstract: OBJECTIVE
  Elderly patients with sinus node dysfunction (SND) are at increased risk of falls with possible injuries. However, the incidence of these adverse events and its reduction after permanent pacemaker (PPM) implantation are not known.
  
  
  RESULTS
  Eighty-seven patients (mean [SD] age 75.4 [8.3] years, 51% women) with SND and an indication for cardiac pacing were included and were examined by a standardized interview targeting fall history. The incidence and total number of falls, falls with injury, falls requiring treatment, and falls resulting in a fracture were assessed for the time period of 12 months before (retrospectively) and after PPM implantation (prospectively). Furthermore, symptoms such as syncope, dizziness, and dyspnea were evaluated before and after PPM implantation. The implantation of a PPM was associated with a reduced proportion of patients experiencing at least one fall by 71% (from 53 to 15%, P < 0.001) and a reduction of the absolute number of falls by 90% (from 127 to 13, P < 0.001) during the 12 months before vs. after PPM implant. Falls with injury (28 vs. 10%, P = 0.005), falls requiring medical attention (31 vs. 8%, P < 0.001), and falls leading to fracture (8 vs. 0%, P = 0.013) were similarly reduced. Notably, fewer patients had syncope (4 vs. 45%, P < 0.001) and dizziness after PPM implantation (12 vs. 45%, P < 0.001).
  
  
  CONCLUSIONS
  Falls, fall-related injuries, and fall-related fractures are frequent in SND patients. Permanent pacemaker implantation is associated with a significantly reduced risk of these adverse events, although no causal relationship could be established due to the study design.
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Brenner
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Ammann
authors.affiliation: Luzerner Kantonsspital Sursee, Sursee, Switzerland.
authors.forename: See-Il
authors.initials: SI
authors.lastname: Yoon
authors.affiliation: Stadtspital Waid, Zürich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Christen
authors.affiliation: Spitalregion RWS St. Gallen, St. Gallen, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Hellermann
authors.affiliation: Hopital de Sion, Sion, Switzerland.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Girod
authors.affiliation: Spital Herisau, Herisau, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Knaus
authors.affiliation: University of Zurich, Zurich, Switzerland.
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
authors.affiliation: GZO Spital Wetzikon, Wetzikon, Switzerland.
authors.forename: Nazmi
authors.initials: N
authors.lastname: Krasniqi
authors.affiliation: Zuger Kantonsspital, Zug, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Ramsay
authors.affiliation: Cardiology/Electrophysiology, University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: Policlinic for Osteoporosis, University and University Hospital of Bern, Bern, Switzerland.
authors.forename: Kurt
authors.initials: K
authors.lastname: Lippuner
authors.affiliation: Cardiology/Electrophysiology, University of Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
keywords: Elderly; Falls; Fractures; Pacemaker; Sick sinus syndrome; Sinus node dysfunction