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Predictors of Pacemaker Dependence and Pacemaker Dependence as a Predictor of Mortality in Patients with Implantable Cardioverter Defibrillator
Author(s) -
SOOD NITESH,
CRESPO ERIC,
FRIEDMAN MEIR,
GUERTIN DANETTE,
ZWEIBEL STEVEN,
KLUGER JEFFREY,
CLYNE CHRISTOPHER A.
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12164
Subject(s) - medicine , implantable cardioverter defibrillator , cardiology , cardiac resynchronization therapy , confidence interval , hazard ratio , odds ratio , amiodarone , atrial fibrillation , proportional hazards model , retrospective cohort study , cohort , logistic regression , single center , heart failure , ejection fraction
Background The prevalence, predictors, and survival for the development of pacemaker dependence (PD) in patients implanted with an implantable cardioverter defibrillator (ICD) are unknown. Methods This was a retrospective analysis of 1,550 consecutive patients with ICD implantation at a single center from 1996 to 2008 with a mean of 4.2 ± 3.4 years. Patients with implant intrinsic heart rates less than 40 beats/min (n = 48) and cardiac resynchronization therapy (n = 444) were excluded leaving 1,058 patients in this study. PD was defined as an intrinsic rhythm <40 beats/min after inhibiting the pacemaker, <50 beats/min with transient symptoms of dizziness relieved by resumption of pacing and right ventricle pacing despite algorithms to promote intrinsic conduction at the 3 monthly follow‐up ICD clinic visits. Multivariate regression and Cox proportional hazard models were used for analysis. Results The mean age was 64 ± 13 years; 79% were male with a primary indication for the ICD in 57%. PD occurred in 142 (13.4%) of patients, with a mean time to PD of 2.6 ± 1.9 years. PD was associated with a 48% increased odds for mortality versus non‐PD ICD patients during the mean follow‐up time of 4.2 ± 3.4 years (adjusted odds ratio = 1.48 [95% confidence interval 1.080–2.042]; P = 0.015). Older age, a history of atrial fibrillation, amiodarone use, and secondary prevention were the strongest predictors for the development of PD. Conclusions In this single‐center ICD cohort, the development of PD was not uncommon and was associated with decreased survival.