It included 1, patients who received their first pacemaker for bradycardia slow or irregular heart rhythm between and Patients were followed for an average of 5. Patients without cardiovascular disease such as heart failure or coronary artery disease at the time of pacemaker implantation had a survival rate similar to age- and sex-matched controls from the general Dutch population see Figure 1.
In this study, we could document that other cardiovascular problems, such as coronary artery disease or heart failure, determine the prognosis of pacemaker patients, rather than the slow heart rhythm itself. Thus, next to the regular technical follow-ups of the pacemaker, the cardiologist should also regularly check the pacemaker recipient to improve the prognosis by treating potentially diagnosed cardiovascular diseases.
Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter. Its mission is to reduce the burden of cardiovascular disease.
Our mission: To reduce the burden of cardiovascular disease. Help centre. The powerful radiation used in radiation therapy for cancer can damage the circuits of a pacemaker. If you need radiation therapy, your pacemaker will need to be specially shielded to protect it from the radiation field.
In general, it makes good sense to remind any of your healthcare providers that you have a pacemaker before they do any medical procedure. Pacemakers are supposed to improve or maintain your lifestyle, not limit it. And for the most part, this is what happens. Once you recover from the implantation surgery, none of the precautions you need to take are particularly burdensome, and you won't encounter most of them during your daily life.
For the most part, once your pacemaker is implanted, you can go through your normal life without ever thinking about it. Follow your healthcare provider's recommendations. You'll likely need to limit activity for a few weeks after surgery while your incision heals. Afterwards, if your healthcare provider says it's OK, you should be able to resume your normal level of activity, but don't overdo it. The right amount of activity should make you feel better, not worse.
A pacemaker can help you to live a normal life span. A study found that the life expectancy for pacemaker patients is similar to the life expectancy for the general population. Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Pacemaker insertion. Ann Transl Med. American Heart Society. Devices that may interfere with ICDs and pacemakers. Updated September 30, American Heart Association.
Living with your pacemaker. Life expectancy after implantation of a first cardiac permanent pacemaker — : A population-based study. Int J Cardiol. J Am Coll Cardiol ; e1. Clinical experience with pacemaker pulse generators and transvenous leads: an 8-year prospective multicenter study. Heart Rhythm. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.
These choices will be signaled globally to our partners and will not affect browsing data. This increase in survival times of patients was observed despite a significant increase in age at implantation, with a mean age at implantation of Kaplan—Meier analysis of survival of patients after pacemaker implantations.
The black line indicates survival of all patients, whereas the colored indicate survival of patients implanted during the three different decades. Long-term survival was significantly influenced by the type of arrhythmia leading to pacemaker implantation: Overall median survival was the longest in patients implanted for sick-sinus syndrome SSS with Similarly, survival proportions at 5, 10, 15 and 20 years were significantly different between groups Table 2. AFIB denotes bradycardic atrial fibrillation.
Estimated survival probabilities of pacemaker-patients a. In addition, the proportion of women was significantly higher in the group of patients implanted for SSS During the study period, a total of women received pacemakers. Overall the mean age of women at pacemaker implantation was significantly higher than the age of men This difference increased throughout the three decades: In the first decade, mean ages of women vs men were Despite the higher age of women at pacemaker-implantation, their median survival time during the year study period was Similarly, survival proportions at 5, 10, 15 and 20 years differed significantly Table 2 , Fig.
Kaplan—Meier analysis of survival according to gender. As expected, age at implantation significantly influenced postoperative survival times: Patients aged less than 70 years at implantation had a median survival of Five-year survival was Finally at years survival proportions were Patients receiving a VVI-pacemaker had a significantly shorter median survival of Using subgroup analysis, baseline ECG-parameters were tested for an influence on survival: analysis was performed on the ECG at presentation, with measurement of the QRS-width of the predominant spontaneous rhythm.
However, when comparing all patients with either LBB or partial left bundle branch block left anterior or left posterior blocks to those with normal QRS-width revealed a significant difference in survival: median survival was No difference was seen between patients with right bundle-branch block and those with a normal QRS.
Regarding differences within the high degree AV-block groups, no differences were seen in survival between 2nd degree AV-block and 3rd degree AV-block. Also the age between the two groups of AV-block did not differ significantly. Included in the study population was a small proportion 0. The median follow up period after implantation for these was Kaplan—Meier survival is depicted in Fig.
Multivariate analysis was performed to identify independent prognostic factors for survival after pacemaker-implantation. Several factors were identified as independent predictors of survival in patients after pacemaker implantation:. The decade of implantation, with patients implanted during the last decade having a significantly longer survival compared to those implanted in the two earlier decades risk-ratio RR 0. As expected the age at implantation influenced survival inversely with younger patients having a significantly longer survival RR for each 1-year age increase 1.
Sick sinus syndrome was independently associated with better survival compared to patients with atrial fibrillation RR 0. Thus the index-arrhythmia remained an independent prognostic parameter after correction for differences in age and gender. Interestingly, symptoms leading to pacemaker implantation were independently associated with survival: Near-syncope was associated with a significantly longer survival than syncope or non-syncopal bradycardias RR 0.
The independent risk factors are summarized in Fig. Multivariate analysis: risk ratios of death of factors influencing survival after pacemaker implantation. A Multivariate analysis of the baseline patient characteristics —; B multivariate analysis of pacing mode. To assess whether the factors influencing survival of patients changed in the last decade from — , we performed a multivariate analysis in this subgroup of patients.
Similar to the results in the whole population, age at implantation was an independent prognostic factors of survival RR: 1. Similar to the entire patient population, symptoms markedly influence survival, with near-syncope being an independent factor for improved survival compared to syncope or non-syncopal bradycardias RR 0.
Since the implantation of the first artificial pacemaker in these devices have become the treatment of choice in bradycardias. Despite its widespread use, overall long-term survival of pacemaker patients has been addressed by only few studies during the last three decades. To avoid a bias due to the learning curve of the very first pacemakers, the study period was started in , whereas the first pacemaker in our hospital was implanted in Thus before the beginning of the study, we had already gathered experience in more than pacemaker-patients treated by the same team ofphysicians.
One of the main results of this study is the longevity of pacemaker patients: approximately one-third of the patients survived for 15 years, with one-fifth of patients surviving up to 20 years. Given the fact, that due to medical advances the life expectancy continues to rise as seen during the last decade this has clear implications on device selection for the subgroup of very long-term survivors: To avoid the risk and the cost of repeated exchanges of pacemaker-devices due to battery depletion, the implantation of devices with a longer battery life and the use of electrodes with high impedance to preserve energy needs to be considered in these groups.
We found several highly significant factors, which influence survival: First of all, gender is an independent prognostic factor for survival in our study: It is well known that the life expectancy of women is higher, and that cardiovascular diseases are delayed in the female gender. Despite women being more than 2 years older at the time of implantation, their overall median survival is still more than 2 years longer compared to men, and the gender difference in survival even increased during the last decade.
Even though gender differences in survival have been reported, neither a differential influence depending on the type of arrhythmia nor this magnitude have been previously reported. Secondly, the symptoms leading to pacemaker implantation are independently associated with survival: Patients experiencing classical Adam—Stokes type syncope and those with asymptomatic bradycardia i.
ECG-documented bradycardia have identical, but worse survival compared to patients with near-syncope as the initial symptom. Clearly it would be interesting to compare the survival of these patients with and without pacemaker therapy, to analyse if pacemaker implantation affects survival at all in this subgroup, however, to the best of our knowledge, no study has yet addressed this question.
Thirdly, the choice of VVI pacing influenced survival adversely, a difference which was more evident during the first two analysed decades. Interestingly, there was no significant difference between AAI and dual-chamber pacemakers, which were both associated with a markedly longer survival than VVI. In a retrospective study of short-term survival with a follow-up of 2 years, Lamas et al. Previous studies showed no significant differences in survival but in symptoms or secondary end-points, especially in patients with sick-sinus syndrome.
The other influencing factors remained significant. One of the main limitations of this study is that we could not control for other factors influencing survival such as left ventricular ejection fraction, medication or other concomitant diseases , as data collection was started in the seventies.
However, no randomized trial has been conducted to date with a similar number and duration of follow-up in pacemaker patients. This clearly shows, that a large, randomized study on the very long-term effects beyond the usual 4—6 years of follow up in previously published trials of pacing mode on survival are warranted. Another limitation of this study is the number of patients with loss of follow-up: We have used a conservative approach and classified patients who were lost for follow-up as being alive on the day of their last visit and being lost for follow-up thereafter.
Given the mean age of these patients 76 years it is likely, however, that a substantial proportion of these patients died thereafter, but our telephone follow up which was performed the day after their missed appointment, i. As these patients were censored at their last visit, this should not affect the estimated survival probabilities according to the Kaplan—Meier method. In the subset of older patients, Jahangir et al. Due to the size and the heterogeneity of this subgroup, a multivariate analysis was not attempted.
However, this subgroup exhibits both a high mortality rate 10 of 34 children died during follow-up but also potentially a very long duration of pacemaker therapy. Clearly, a larger study on the characteristics of long-term survivors after pacemaker implantation in children would be very interesting. Interestingly, the presence of left bundle-branch block—which has been shown to be associated with worse survival in patients with tachyarrhythmias or coronary artery disease—is not an independent factor for survival: Overall patients with complete LBBB showed only a trend towards a shorter survival, but it was not an independent risk factor in multivariate analysis.
A delay in left ventricular conduction LBBB and LAHB influenced survival in univariate analysis, but also was not independently associated with survival in multivariate analysis. Regarding the last decade—which is probably the most important to influence clinical practice in the future—multivariate independent prognostic factors at baseline were: gender, age at implantation and symptoms; however, neither index arrhythmia nor mode of pacing were significant after correction for other factors.
This may—at least in part—also be due to the markedly shorter observation period of patients implanted during the nineties, and due to the fact that overall survival has markedly increased compared to the previous two decades.
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