Should Age be Consideration in Mode Selection in Permanent Pacing? Survival Analysis

Although it has been suggested that functional benefits from dual-chamber pacing may be greater in the elderly than in the younger patient population partially due to age-related decrease in cardiac compliance, the relative impact on long-term survival with respect to mode of pacing and age has not been established. To assess interactions between age and pacing mode, we analyzed survival outcome of 631 patients ≥70 yrs of age paced between 1980 to 1985. There were 260 women and 371 men. Mean age was 78 ± 6 yrs (range 70 to 98 yrs), and mean follow-up was 5.2 ± 3.2 yrs. Forward stepwise Cox regression analysis identified several independent risk factors for increased mortality, including: age, CHF, MI, diabetes, renal failure, and cancer. Dual-chamber pacing was also an independent predictor for improved survival (X2 = 11.4, p ≤ 0.0001). Survival was further analyzed, stratified by both age and pacing mode as shown below: When the interaction between pacing mode and age was included in the multivariate proportional hazard model, there was clear trend of interaction (X2 = 3.46, P = 0.06). These findings suggest that beneficial effects of dual chamber pacing on long-term survival may be greater in older patients. Selection of dual chamber pacing should be considered in the elderly.