Pacemaker Implantation in the Extreme Elderly

Right Atrial (A), Right Ventricular (B), and Left Ventricular (C) Leads Before (Pre) and After (Post) Dislodgements. Right atrial lead became dislodged after patient twiddled with device. Right ventricular lead dislodged by moving more basilar in position (arrow) one day after implant. Left ventricular lead dislodged and reseated itself in the body of coronary sinus 3 months after initial placement (arrow).

     There are scant data for pacemaker implant complications and readmission rates in the extreme elderly (age≥80 years) despite their common use in this population.   We performed a retrospective chart review of consecutive patients (n=149, age≥80 years) who underwent pacemaker implantation at our community hospital Electrophysiology program from July 2008 through June 2010.  Single-, dual-, and biventricular-chamber pacemakers and generator changes were included for analysis; cardioverter-defibrillator devices, temporary pacemakers, and loop recorders were excluded.  Standard procedures for implantation were used.   Major complications defined as death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arterial-venous fistula.  Minor complications defined as drug reaction, conduction block, hematoma or lead dislodgement requiring reoperation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection.

     The overall mean age of implantation was 86 years.  There were no intraprocedural complications. There was one major in-hospital (0.7%) and one minor in-hospital complication (0.7%).  Within 30 days of implant, there was an overall 5.4% rate of complications; 4 minor (2.7%) and 4 major (2.7%).  There was a 30d cardiovascular-attributable mortality of 0.7% and an all-cause mortality of 2%.  There was a 5.4% rate of readmission within 30days of implantation.

Our report of pacemaker implantations in the extreme elderly reveals rates of implant complications comparable to data from younger patient populations while experiencing a higher 30day all-cause mortality (that may be attributable to elevated all-cause mortality rates in this age-group).

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