title: Prognosis of super-elderly healthy Japanese patients after pacemaker implantation for bradycardia.
abstract: The prognosis of super-elderly patients (age≥85 years) who undergo bradycardia pacemaker (PM) implantation remains unknown.
  
  
  
  We retrospectively enrolled 868 patients (men 49.0%, 76.6±10.6 years) who could walk unassisted and whose expected life expectancy was more than 1 year, receiving their first bradycardia PM implantation between January 1, 2006, and June 30, 2013. Clinical outcomes were compared between super-elderly patients (n=201, mean age 88.6±3.2 years) and younger patients (n=667, 73.0±9.3 years).
  
  
  
  At the end of a median 1285-day follow-up, 128 patients (14.7%) died, of which 54 were cardiac deaths (42.2%). Mortality rates were similar between the groups (16.4% vs. 14.2%, log-rank p=0.56) and across different indications for implantation (atrio-ventricular conduction disturbance or sick sinus syndrome, p=0.59), initial rhythms (sinus rhythm or persistent atrial fibrillation, p=0.62), pacing modes (dual chamber pacing or VVI pacing, p=0.26), and ventricular lead positions (septum or apex, p=0.52). On Cox proportional hazard model analysis, hypertension [hazard ratio (HR)=1.74, 95% confidence interval (CI)=1.19-2.54, p=0.004], diabetes mellitus (HR=2.18, 95% CI=1.51-3.14, p<0.001), history of myocardial infarction (HR=3.59, 95% CI=2.49-5.16, p<0.001), and history of stroke (HR=2.26, 95% CI=1.51-3.37, p<0.001) were independent predictors for mortality.
  
  
  
  The mortality rate of super-elderly patients who had no critical illnesses and were healthy enough to walk unassisted at the time of PM implantation was not inferior to that of younger patients. Prognosis was determined by comorbidities, but not by age, PM indication, initial rhythm, pacing leads, or mode.
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan; Department of Cardiology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan. Electronic address: tetsuo5672@yahoo.co.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Hijikata
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miwa
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sekigawa
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Nagata
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nozato
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Obayashi
authors.affiliation: Department of Cardiology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy; D001919:Bradycardia / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000453:epidemiology / Q000628:therapy
keywords: Elderly; Pacemaker; Prognosis