Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in comparison to the age- and sex-matched general population, assess changes in baseline characteristics over three decades of the inclusion period and determine the association between selected variables and patient survival. Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performed between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter university hospital. Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time. Compared to the general population, the observed survival was significantly inferior until 12 years post DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics over three decades revealed the following significant changes: more elderly patients, more female patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter (AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades. In multivariate analysis male sex and higher age were the only variables significantly associated with shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device infection were not associated with survival. Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associated with survival were sex and baseline age at first implantation