Procedural safety and long-term follow-up after pacemaker implantation in nonagenarians

Duc Dang (1, 2, 3, 4) , Vincent Galand (2, 1, 4) , Aurelie Loirat (1, 2, 4) , Vincent Auffret (2, 4) , Nathalie Behar (5, 2, 4) , Philippe Mabo (5, 2, 4) , Jean-Claude Daubert (1, 2, 4) , Christophe Leclercq (5, 2, 4) , Raphael P. Martins (5, 2, 4)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 LTSI - Laboratoire Traitement du Signal et de l'Image
3 CHU Bordeaux
4 CIC-IT Rennes
5 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]

Background - The rate of pacemaker (PM) implantations is constantly growing. Since life expectancy of the population is projected to increase, a large number of nonagenarian patients will need PM implantation. We aimed at analyzing short- and long-term outcomes after PM implantation in nonagenarians. Methods - Patients aged ≥90 years referred for PM implantation from 2004 to 2017 were included. The primary clinical endpoint was total mortality. Secondary endpoints included procedure-related and in-hospital complications. Results - A total of 172 patients were included (92.6 ± 2.1 years, from 90.0 to 101.4 years). Procedure duration was 50.0 ± 19.7 minutes. Most of the patients had VVI devices implanted (143 pts, 83.1%) and mean hospital stay was 3.5 ± 1.5 days. Nine patients (5.2%) had short-term device-related complications and 29 patients (16.8%) had post-procedural complications, non-related to the implantation, including four leading to patients' death. During a follow-up of 22.5 months (interquartile range: 7.3-38.0), 94 patients (54.7%) died. Survival rates were 82.9% (95% confidence interval [CI]: 76.0-88.0), 73.7% (95% CI: 65.7-80.1) and 37.5% (95% CI: 27.5-47.5) after 1, 2, and 5 years, respectively. The Charlson comorbidity index was a predictive factor of procedural complications (odds ratio = 1.33; 95% CI: 1.05-1.69, P = 0.02) while having a complication (hazard ratio [HR] = 4.04; 95% CI: 1.79-9.11, P = 0.001) and atrial fibrillation (HR = 1.63; 95% CI: [1.02-2.63], P = 0.043) were predictors of post-implantation death. Conclusion - PM implantation in nonagenarians is safe, with a low risk of procedural complications, but many comorbidities-related complications can occur. Caution should be taken in this old and frail population since complications significantly impact patients' survival.

Mots clés: nonagenarian; pacemaker; complications

Domaines: Ingénierie biomédicale

Duc Dang, Vincent Galand, Aurelie Loirat, Vincent Auffret, Nathalie Behar, et al.. Procedural safety and long-term follow-up after pacemaker implantation in nonagenarians. Clinical Cardiology, 2018, 41 (10), pp.1315-1321. ⟨10.1002/clc.23083⟩. ⟨hal-01934991⟩