Study On Safety And Long-term Prognosis Of Device Implantation For Elderly Patients

Objective:With the continuously improvement of Device-Based-Therapy,Permanent Pacemakers,ICD,CRT/CRTD have been widely used in clinical practice.However,elderly patients are often complicated with more comorbidities,and their safety and long-term prognosis are controversial.Position paper for management of elderly patients with cardiac pacemakers and implantable cardiac defibrillators in 2016 suggests that age should not be a contraindication to pacemaker and CRT,but elderly patients should be cautious in ICD implantation^[1].The purpose of this article is to investigate the safety and long-term prognosis of Device-Based-Therapy for elderly patients and provide reference for clinical practice.Method:A retrospectively study was performed on 815 patients aged 70 years and above with newly permanent pacemakers,ICD,CRT/CRTD implanted in the First Affiliated Hospital of Dalian Medical University from January 1,2002 to December 31,2013.215 cases were lost due to poor compliance or change of contact information,and600 cases completed follow-up.Among them 576 cases were permanent pacemakers,19 cases were ICD?including CRTD?and 17 cases were CRT?including CRTD?.The clinical data,surgical data and program data of the above patients were reviewed and followed up by telephone,the follow-up mainly included the survival condition and the cause of death.The endpoint was 5 years after operation or all-cause death.Result:1.A total of 600 patients aged 70 and above were included in this study,with an average age of 76.56 years old.There were 576 cases of Permanent Pacemakers?452 cases in DDD/DDDR mode and 124 cases in VVI/VVIR mode?,19 cases of ICD/CRTD,17 cases of CRT/CRTD.According to the endpoint,the patients were divided into survival group and death group,with 501 cases in survival group and 99 cases in death group.2.The perioperative complication rate after device implantation was 3.83%,including electrode dislocation 41.67%,infection 29.17%?all with pocket infection?,electrode rupture 12.50%,pocket hematoma 8.33%,poor healing of incision 4.17%,intraopera-tive electrode perforation 4.17%.3.After 5 years of follow-up,the survival rate of the patients was 83.5%,and the cardiac death was 42.42%,infection 12.12%,tumor 10.10%,other causes 30.30%,and unknown causes 5.05%.Log Rank,Breslow test and COX regression model suggest that age is associated with long-term prognosis,and the prognosis of patients aged more than 80 years is worse than that of patients aged 70-74 years?OR=1.797,P=0.027?.However,heart failure,ischemic stroke and chronic obstructive pulmonary disease are more important prognostic risk factors than age?OR=3.126,2.219,2.605,P=0.000,0.004,0.001?.4.The 5-year postoperative mortality of ICD/CRTD,CRT/CRTD,and pacemaker were52.63%,52.94%,and 14.93%,respectively.The survival rates of different device types are statistically different?P=0.000?,indicating that the long-term prognosis of ICD and CRT is worse than that of pacemakers.The survival of DDD mode and VVI mode pacing is statistically different?12.17%,25.00%,P=0.000?,which may have selection bias,but the perioperative complication rates of the two modes are not statistically different?3.32%,2.42%,P=0.536?.Conclusion:The results of this study suggest that the implantation of permanent pacemakers,ICD and CRT in elderly patients is safe,the long-term prognosis of patients treated with permanent pacemaker is good,and the long-term prognosis of implantation of ICD and CRT/CRTD is poor,which needs further study.Age affects survival,and the prognosis of patients over 80 years old is worse than that of patients between 70 and 74 years old,but comorbidities such as heart failure,ischemic stroke and chronic obstructive pulmonary disease are more important prognostic risk factors than age.Compared with VVI mode,DDD mode has no significant increase in perioperative complications.Because of selection bias,we cannot indicate the long-term prognosis of DDD mode is better than VVI mode.