Advertisement

Significance of Asymptomatic Bradycardia for Subsequent Pacemaker Implantation and Mortality in Patients >60 Years of Age

      Sinus bradycardia may be more significant in older patients than in a younger group because it could signal important or advanced conduction system and/or cardiac disease potentially modifiable with pacemaker implantation. We evaluated the clinical need for subsequent pacemaker implantation and mortality rate in outpatients >60 years of age with relatively asymptomatic bradycardia (heart rate <55 beats/min without a subsequent pacemaker implantation within 2 weeks) or not (heart rate 60 to 70 beats/min). The 2 groups were matched against pacemaker implantation and death records but without data on indication or cause. Kaplan–Meier survival curves and univariate and multivariable models examined pacemaker implantation and all-cause mortality. The cohort consisted of 470 patients with and 2,090 without asymptomatic bradycardia. Mean follow-up period was 7.2 ± 2.9 years during which 137 patients (5.4%) underwent pacemaker implantation and 748 (29.2%) died. Incidence of pacemaker placement was higher in the bradycardia cohort (9% vs 5%, p <0.001). The higher incidence of pacemaker implantation did not appear in the first 4 years. Univariate analysis showed no increase in mortality in the bradycardia group (hazard ratio 0.87, 95% confidence interval 0.72 to 1.04, p = 0.130), whereas multivariable analysis showed protection (hazard ratio 0.78, 95% confidence interval 0.65 to 0.94, p = 0.010). In conclusion, older patients with asymptomatic bradycardia have a very low rate of pacemaker implantation, annualized to <1% per year. Their higher rate of pacemaker implantation compared to outpatients without bradycardia shows a latency period of approximately 4 years. It has no adverse impact on all-cause mortality and may even be protective.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Voulgari C.
        • Tentolouris N.
        Assessment of the spatial QRS-T angle by vectorcardiography: current data and perspectives.
        Curr Cardiol Rev. 2009; 5: 251-262
        • Cowper D.C.
        • Kubal J.D.
        • Maynard C.
        • Hynes D.M.
        A primer and comparative review of major US mortality databases.
        Ann Epidemiol. 2002; 12: 462-468
        • R Development Core Team
        R: A Language and Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2010
        • Fox K.
        • Borer J.S.
        • Camm A.J.
        • Danchin N.
        • Ferrari R.
        • Lopez Sendon J.L.
        • Steg P.G.
        • Tardif J.C.
        • Tavazzi L.
        • Tendera M.
        • Heart Rate Working Group
        Resting heart rate in cardiovascular disease.
        J Am Coll Cardiol. 2007; 50: 823-830
        • Hodgson J.L.
        • Buskirk E.R.
        Physical fitness and age, with emphasis on cardiovascular function in the elderly.
        J Am Geriatr Soc. 1977; 25: 385-392
        • Kuzuya M.
        • Enoki H.
        • Iwata M.
        • Hasegawa J.
        • Hirakawa Y.
        J-shaped relationship between resting pulse rate and all-cause mortality in community-dwelling older people with disabilities.
        J Am Geriatr Soc. 2008; 56: 367-368
        • Bangalore S.
        • Messerli F.H.
        • Ou F.S.
        • Tamis-Holland J.
        • Palazzo A.
        • Roe M.T.
        • Hong M.K.
        • Peterson E.D.
        • CRUSADE Investigators
        The association of admission heart rate and in-hospital cardiovascular events in patients with non–ST-segment elevation acute coronary syndromes: results from 135 164 patients in the CRUSADE quality improvement initiative.
        Eur Heart J. 2010; 31: 552-560
        • Kolloch R.
        • Legler U.F.
        • Champion A.
        • Cooper-Dehoff R.M.
        • Handberg E.
        • Zhou Q.
        • Pepine C.J.
        Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST).
        Eur Heart J. 2008; 29: 1327-1334
        • Cheng S.
        • Keyes M.J.
        • Larson M.G.
        • McCabe E.L.
        • Newton-Cheh C.
        • Levy D.
        • Benjamin E.J.
        • Vasan R.S.
        • Wang T.J.
        Long-term outcomes in individuals with prolonged PR Interval or first-degree atrioventricular block.
        JAMA. 2009; 301: 2571-2577
        • Cheng S.
        • Larson M.G.
        • Keyes M.J.
        • McCabe E.L.
        • Newton-Cheh C.
        • Levy D.
        • Benjamin E.J.
        • Vasan R.S.
        • Wang T.J.
        Relation of QRS width in healthy persons to risk of future permanent pacemaker implantation.
        Am J Cardiol. 2010; 106: 668-672
        • Desai A.D.
        • Yaw T.S.
        • Yamazaki T.
        • Kaykha A.
        • Chun S.
        • Froelicher V.F.
        Prognostic significance of quantitative QRS duration.
        Am J Med. 2006; 119: 600-606
        • Rautaharju P.M.
        • Kooperberg C.
        • Larson J.C.
        • LaCroix A.
        Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women: the Women's Health Initiative.
        Circulation. 2006; 113: 473-480
        • Chugh S.S.
        • Jui J.
        • Gunson K.
        • Stecker E.C.
        • John B.T.
        • Thompson B.
        • Ilias N.
        • Vickers C.
        • Dogra V.
        • Daya M.
        • Kron J.
        • Zheng Z.J.
        • Mensah G.
        • McAnulty J.
        Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.
        J Am Coll Cardiol. 2004; 44: 1268-1275