Likewise, the use of pacemakers markedly changed during the study period: in the seventies, The age of the patients at implantation increased with the decades, as patients implanted were progressively older than those of the previous decades Table 1.
Similarly, the indications for pacemaker implantation shifted, with an increase in the number of patients implanted for sick sinus syndrome, and a decrease in the number of patients implanted for pauses in atrial fibrillation Table 1. Significant differences were seen in the survival of patients during the decades: As seen in Fig.
Median survival was At 5 years after first pacemaker-implantation, Similarly, survival at years post implant was At 15 years after implantation, nearly a quarter 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. Their ages ranged from 70 to 87 years, with an average of An epicardial electrode was implanted in 13 patients and an endocardial electrode in The pacemaker was implanted in 76 patients for symptomatic atrioventricular block and in four patients for sick-sinus syndrome.
Two patients 2. Also, if you are selected for a more detailed search, politely remind security not to hold the hand-held metal-detecting wand over the pacemaker for a prolonged period of time more than a second or two. This is because the magnet inside the wand may temporarily change the operating mode of your device. Do not lean against or stay near the system longer than needed. Avoid magnetic resonance imaging MRI machines or other large magnetic fields.
These may affect the programming or function of the pacemaker. Also, the rapidly changing magnetic field within the MRI scanner can may cause heating of the pacemaker leads. There are usually other options to MRI for people with pacemakers, but if your doctor determines that you must get an MRI scan, discuss it with your cardiologist first.
If he or she and you agree to go ahead, you should be closely monitored by a cardiologist, with a pacemaker programming device immediately available, during MRI scanning. Newer pacemaker and ICD technology may be a safe option for MRI as long as monitoring and certain safety precautions are used. Turn off large motors, such as cars or boats, when working on them.
They may temporarily "confuse" your device with the magnetic fields created by these large motors. Avoid certain high-voltage or radar machines, such as radio or T. Cell phones available in the U. A general guideline is to keep cell phones at least 6 inches away from your device.
Avoid carrying a cell phone in your breast pocket over your pacemaker or ICD. MP3 player headphones may contain a magnetic substance that could interfere with your device function when in very close contact. Keep the headphones at least 1. They can be worn properly in the ears and not pose this risk.
Do not drape your headphones around your neck, put your headphones in your breast pocket, or allow a person with headphones in to press against your device. If you are having a surgical procedure done by a surgeon or dentist, tell your surgeon or dentist that you have a pacemaker or ICD. Some procedures require that your ICD be temporarily turned off or set to a special mode.
This will be determined by your cardiologist. Temporarily changing the mode on your pacemaker can be done noninvasively no additional surgery is required , but should only be done by qualified medical personnel. Shock wave lithotripsy, used to get rid of kidney stones, may disrupt the function of your device without appropriate preparation. Ensure that your doctor is aware you have a pacemaker or ICD before scheduling this procedure.
Transcutaneous electrical nerve stimulation TENs to treat certain pain conditions may interfere with your pacemaker of ICD. Inform your doctor if you are considering this therapy.
Therapeutic radiation, such as that used for cancer treatments, can damage the circuits in your device. The risk increases with increased radiation doses.
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