Paciente anciano portador de marcapasos: Características y evolución en función del tipo de dispositivo empleado

Abstract

Objective The objectives of this study were two-fold: a) to describe the characteristics of a group of elderly patients with pacemakers, and b) to evaluate clinical and functional outcomes and mortality in these patients according to the type of device implanted during a 4-year follow-up. Material and methods Retrospective study of patients over 75 with a pacemaker performed through a review of medical records. Previous diseases, medications, clinical and electrocardiographic findings, and functional data (the functional and mental evaluation scales of the Spanish Red Cross [CRF, CRM]), were evaluated. To gather data on functional outcomes, morbidity and mortality, telephone interviews were conducted 4 years after pacemaker implantation. Statistical analysis consisted of comparison of means and proportions and logistic regression analysis with 95% confidence intervals ( p<.05). The SPSS 12.0 package was used. Results 144 patients (59.7% men) with a mean age of 82.9 years (SD 5.0) were evaluated. At implantation, most patients had good physical and mental status (CRF ≤ 2: 90%; CRM ≤ 2: 96.2%). Most patients had a history of cardiovascular disease. The main indications for pacemaker implantation were syncope (43.1%) and dizziness (31.9%) due to high-grade atrioventricular block and slow atrial fibrillation. In 71.5% of the patients, a single-chamber device was used. These patients were older ( P<.05) but had identical functional and mental status to those receiving a dual-chamber device. There were no severe complications. During follow-up (n=130 patients), 36.2% of the patients developed some degree of heart failure. The incidence of heart failure, onset of atrial fibrillation, stroke and pacemaker syndrome was slightly lower in patients with dual-chamber devices but this difference was not statistically significant ( P>.05). Functional and cognitive status at the end of the study showed no statistically significant differences between the two groups. Of 125 patients, 47 (37.6%) died. Mortality was lower in patients with dual-chamber devices than in the single-chamber group ( P<.01) but patients in the former group were younger ( P<.01). This difference was maintained in the logistic regression analysis. Conclusions In our sample of elderly patients with syncope and high-grade atrioventricular blockade, there was a tendency to implant single-chamber pacemakers. Dual-chamber devices were associated with lower mortality and fewer cardiovascular events during follow-up, although no statistically significant differences were found.