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Relation between mode of pacing and long-term survival in the very elderly

Arshad Jahangir, MD^*, Win-Kuang Shen, MD, FACC^*, Sharon A. Neubauer^*, David J. Ballard, MD, PhD, Stephen C. Hammill, MD, FACC^*, David O. Hodge, Christine M. Lohse, Bernard J. Gersh, MB, DPhil, ChB, FACC^* and David L. Hayes, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Clinical Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

View larger version (24K): [in a new window]   Figure 1 Permanent pacemaker implantation in octogenarians and nonagenarians between 1980 and 1992. Patients with chronic atrial fibrillation or carotid sinus hypersensitivity were excluded.

View larger version (17K): [in a new window]   Figure 2 Long-term overall survival in octogenarians and nonagenarians after implantation of a dual-chamber or ventricular pacemaker. The observed survival in patients with a ventricular pacemaker is significantly worse than those with a dual-chamber pacemaker. The numbers below the graph indicate the number of patients at risk at each point.

View larger version (22K): [in a new window]   Figure 3 A: Observed survival in patients with high grade atrioventricular block was significantly worse than expected survival of control population. B: Observed survival in patients with sinus node dysfunction was similar to expected survival of control population.

View larger version (17K): [in a new window]   Figure 4 Long-term survival rates in the octogenarians and nonagenarians with high grade atrioventricular block after implantation of ventricular or dual-chamber pacemaker.

View larger version (16K): [in a new window]   Figure 5 Long-term survival rates in octogenarians and nonagenarians with sinus node dysfunction after implantation of a ventricular or dual-chamber pacemaker.