Long term quality-of-life in patients with bradycardia pacemaker implantation

Background

Health-related quality of life (HRQoL) values shortly after pacemaker (PM) implantation for bradycardia have been established, however little is known about long-term HRQoL.

Methods

Using the generic SF-36 and the PM specific Aquarel questionnaire, HRQoL was repeatedly measured during a 7.5 year follow-up period in 881 bradycardia PM recipients included in the large scale nationwide Dutch FOLLOWPACE study. HRQoL over time, corrected for age, gender, diabetes, hypertension, heart failure, cardiovascular disease and AV-synchrony, was assessed with a linear mixed model.

Results

Increased scores both on overall SF-36 and on all SF-36 subscales were observed shortly after implantation. Although scores on SF-36 gradually declined over time, scores remained improved over the measured pre-implantation values. Also, scores for almost all subscales remained increased throughout the 7.5 year observation period, except for physical functioning which showed a gradual decline several years after the initial rise.Additionally, higher scores on all Aquarel scales were observed after implantation. Scores on the arrhythmias and chest discomfort subscales improved and remained stable throughout follow-up (FU), whereas the dyspnea at exertion subscale showed a gradual decline during FU to reach pre-implantation values at 5 years.

Conclusions

Increased HRQoL is observed not only shortly after PM implantation, but also after long-term FU.

Clinical Trial Registration

ClinicalTrials.gov Identifier: NCT00135174; http://www.clinicaltrials.gov/ct2/show/NCT00135174.     

Seasonal distribution of pacemaker implantation for symptomatic bradycardia

Permanent cardiac-pacemaker therapy is widely recognized as beneficial in the treatment of various types of symptomatic bradycardia. However, the seasonal distribution of pacemaker implantation has never been discussed. The purpose of this study was to investigate the seasonal distribution of pacemaker implantation in a large population of patients with symptomatic bradycardia. The study population consisted of 904 patients who underwent implantation of a new permanent pacemaker between January 1999 and December 2001 and were registered in the database of CPI Company in Taiwan. The number of pacemaker implantations in each month was analyzed to investigate the seasonal distribution of pacemaker implantations in a year. The number of patients who underwent pacemaker implantation between October and December was significantly higher than that of other seasons (P < 0.007). The results indicate that there is a tendency for bradyarrhythmic patients to have symptoms between October and December.     

起搏器家庭监测功能对安置起搏器患者监测报警事件的观察

目的观察家庭监测(HM)功能对安置起搏器患者监测报警事件的应用。方法植入带有HM系统的双腔或三腔起搏器患者28例,随访15.71±9.73个月,记录系统传送的事件及返院随访的情况。结果 17例(61%)患者传送了报警事件。临床心血管事件报警8例,其中心房颤动报警最为多见,较常规随访提早发现32.2±19.0天。起搏系统报警事件14例(34次),其中以P波感知不良报警次数最多,为17次,较常规随访提早发现42.5±25.3天。结论 HM系统可在下一次常规随访前提早发现报警事件,有助于起搏器术后患者的实时监测和随访。     

Secondary infections after pacemaker implantation

INTRODUCTION: Infectious complications following pacemaker implantation are not common but may be particularly severe. Localized wound infections at the site of implantation have been reported in 0.5% of the cases in the most recent series, with an average of about 2%. The incidence of septicemia and infectious endocarditis is lower, about 0.5% of the cases. The operator's experience, the duration of the procedure and repeat procedures are considered to be predisposing factors. CURRENT KNOWLEDGE AND KEY POINTS: The main cause of these infections has been recently demonstrated to be local contamination during implantation. The commonest causal organism is Staphylococcus (75 to 92% of the cases), Staphylococcus aureus being the cause of acute infections (less than 6 weeks), whereas Staphylococcus epidermidis is associated with cases of secondary infection (more than 2 months). The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the implanted material, septic emboli or phlebitis have been described. The diagnosis is confirmed by local and systemic biological investigations and by echocardiography (especially transesophageal echocardiography) in cases of right heart endocarditis. There are two axes of treatment: bactericidal double antibiotherapy and surgical ablation of the infected material either percutaneously or by cardiotomy. FUTURE PROSPECTS AND PROJECTS: A recent meta-analysis supported the role of systematic, preoperative, prophylactic antibiotic therapy in the prevention of these complications. These data should be confirmed by suitably powered clinical trials.     

起搏器术后切口渗血2例

本文将2例起搏器综合征(PMS)特殊表现———术后切口渗血报道如下。例1女,13岁,因室间隔缺损修补术后出现Ⅲ度房室传导阻滞、结性逸搏心律、反复晕厥入院。入院时心率41次/min,血压117/66 mmHg(1mmHg=0·133 kPa)。行VVI起搏器置入术,起搏频率设定为60次/min。心电图示起搏器起     

Prognosis after pacemaker implantation in extreme elderly

AimsSignificant comorbidities may limit the potential benefit of pacemaker (PM) implantation in extreme elderly. A short-term mortality risk prediction score, able to identify high-risk patients, may be a useful tool in this population.Methods and resultsWe retrospectively analyzed 538 patients aged >80 years at the time of implant who underwent PM implantation. Kaplan-Meier survival and multivariable Cox regression analyses were performed to identify patient, procedural or complication variables predictive of death. The ACP (Aging in Cardiac Pacing) Score was constructed by assigning weighted values to the variables identified by hazard ratios, combined into an additive mortality risk score equation. One, two and three-year overall mortality rate was 11%, 21% and 32% respectively. Renal failure (HR 1.63; CI 1.15–2.31; p = .006), active neoplasia (HR 1.78; CI 1.27–2.51; p = .008), connective tissue disorder (3.07; CI 1.34–7.08; p = .048), cerebrovascular disease (HR 1.75; CI 1.25–2.46; p = .001) and the use of a single lead device (HR 2.27; CI 1.6–3.24; p < .001) were independently associated with worse survival. The ACP Score showed discrete predictive ability (AUC 0,6792 CI 0,63-0,73). Kaplan-Meier survival curves comparing low vs high ACP Scores demonstrated that low ACP scores were associated with reduced mortality rates (p < .001).ConclusionsSignificant comorbidities were associated with worse survival after PM implantation in extreme elderly. The ACP Score is a novel tool that may help to identify patients with high mortality risk after device implantation.     

Atrial fibrillation after DDDR pacemaker implantation

INTRODUCTION: Newer implantable pulse generators have data storage capabilities that permit detection of multiple episodes of atrial fibrillation (AF). This study evaluated the clinical predictors and time course of AF development in a general pacemaker population. METHODS AND RESULTS: Patients (n = 231) received DDDR pacemakers with features that permit detection and storage of information about the date, time of onset, and duration of multiple, sequential episodes of AF. Patients were followed for 718+/-383 days. Time to first occurrence of AF, interval between first and second episode of AF, and total AF burden were determined at each follow-up visit. AF occurred more often in patients (68%) with sinus node disease than in patients with AV block (37%; P < 0.001). Time to first occurrence of AF was 21.2 days (95% confidence interval [CI] 14.7 to 30.6 days) after pacemaker implantation. AF burden initially decreased significantly in patients (0.8 hours/day, 95% CI 0.7 to 0.9 at 8 weeks after implant vs 0.6 hours/day, 95% CI 0.4 to 0.8 at 12 months after implant; P = 0.005) but then increased significantly during long-term follow-up (2.0 hours/day, 95% CI 1.0 to 3.7 at 48 months after implant; P = 0.008). The long-term increase in AF burden was seen predominantly in patients with sinus node disease. A prior history of AF and the duration of follow-up were independent predictors of AF occurrence. CONCLUSION: AF develops frequently after dual-chamber pacemaker implantation. AF burden increases progressively over the long term.     

Pulmonary embolism after pacemaker implantation.

One day after implantation of a permanent pacemaker in an 82-year-old man, transthoracic echocardiography showed a mass in the right ventricle and a small pericardial effusion. Transesophageal echocardiography revealed a mass attached to the pacemaker lead. Subcutaneous administration of enoxaparin was begun, and the patient remained free of symptoms for the duration of his hospital stay Follow-up echocardiography performed before discharge failed to show the right ventricular mass, but a lung perfusion scan revealed multiple bilateral perfusion defects consistent with pulmonary emboli. The patient was discharged on a regimen of enoxaparin for another 30 days. Two years later, he remained asymptomatic.     

Tei指数联合B型利钠肽原对起搏器患者术后心功能的评价

目的：探讨Tei指数和血浆N末端B型利钠肽原（NT-proBNP）水平对起搏器患者术后心功能评价的价值。方法：行永久起搏器植入术患者168例,起搏模式均为心室按需起搏（VVI）,术前,术后3个月、12个月行Tei指数、血清NT-proBNP、左室射血分数（LVEF）及E/A峰比值等检测,计算心室累积起搏（CumVP）比例（%）。按心室起搏比例区分为CumVP〈30%组（38例）,CumVP 30%～75%组（56例）,CumVP〉75%组（74例）3组。分析Tei指数与NT-proBNP在不同起搏指数患者之间的变化。结果：与术前比较,术后12个月Cum-VP〉75%组NT-proBNP[（124.88±12.56）ng/L比（168.42±32.46）ng/L]与Tei指数[（0.52±0.04）比（0.68±0.06）]显著升高（P〈0.05～〈0.01）,LVEF[（0.56±0.02）比（0.48±0.05）]显著降低（P〈0.05）;与术前比较,术后CumVP〈30%组上述指标的变化差异无显著性（P〉0.05）,CumVP 30%～75%组,Tei指数明显升高[（0.54±0.14）比（0.66±0.01）,P〈0.05],而BNP、LVEF变化差异无显著性（P〉0.05）。结论：起搏器患者心功能改变与起搏比例有关,N末端B型利钠肽原水平与Tei指数可作为评价术后心功能的指标。     

Permanent pacemaker implantation late after transcatheter aortic valve implantation

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Hypoxemia after implantation of a permanent pacemaker

We describe a case in which the patient developed profound, intermittent hypoxemia after implantation of a permanent pacemaker and subsequently after revision of its leads. Cardiac catheterization demonstrated right-to-left shunting at the level of the atria in the presence of a patent foramen ovale that required closure, resulting in the resolution of symptoms. Our report highlights the fact that the presence of a patent foramen ovale with intermittent right-to-left shunting should be considered in a differential diagnosis of hypoxemia after implantation of heart rhythm devices.     

85 岁高龄老人起搏器植入致心肌穿孔1 例

1临床资料 患者男性,85岁,1991年心电图发现缺血性改变,1996年开始出现阵发性房颤,2004年8月房颤发作时心室率减至50-60次／min。入院前2h,患者活动后感心前区闷痛,心电图示心房扑动（图1A）,为诊治入院。