Prognostische Bedeutung einer Schrittmacherabhängigkeit nach Schrittmacherimplantation
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Each year, approximately 100,000 pacemakers are implanted in Germany. A proportion of patients subsequently develop pacemaker dependency, whose prognostic relevance has so far been insufficiently investigated in the literature. The present study therefore aimed to assess the prognostic significance of pacemaker dependency and to identify predictors of all-cause mortality in patients with permanent pacemakers. A total of 786 patients who had already been enrolled in 2018 as part of a previous doctoral project at the pacemaker and defibrillator outpatient clinic of the University Hospital Marburg and had been evaluated for pacemaker dependency were followed up in the present study for a mean period of 42 ± 16 months. Pacemaker dependency was defined as the absence of intrinsic ventricular activity at a rate of ≥ 30 bpm.
During follow-up, 63 of 130 pacemaker-dependent patients (48 %) and 241 of 656 non-dependent patients (37 %) died. Multivariate analysis identified four independent predictors of all-cause mortality: age (HR = 1.07; 95 %-CI: 1.05–1.08; p < 0.01), history of atrial fibrillation (HR = 1.32; 95 %-CI: 1.03–1.69; p < 0.01), chronic kidney disease (HR = 1.28; 95 %-CI: 1.00–1.63; p = 0.048) and NYHA functional class III or IV (HR = 2.00; 95 %-CI: 1.52–2.62; p < 0.01). Pacemaker dependency was associated with all-cause mortality in univariate analysis but did not remain an independent predictor in the multivariate model (HR = 1.15; 95 %-CI: 0.86–1.54; p = 0.35). Similarly, arterial hypertension, left ventricular ejection fraction < 30 %, coronary artery disease, β-blocker or diuretic use, type of antibradycardic pacemaker, bradyarrhythmia as the pacemaker indication and the proportion of ventricular pacing were all associated with higher mortality in univariate analysis but lost significance in the multivariate model.
In conclusion, pacemaker dependency appears to be a marker rather than an independent predictor of all-cause mortality in patients with permanent pacemakers. Patients with pacemaker dependency therefore do not face an inherently increased risk of death due to dependency itself. However, the underlying cardiac diseases and comorbidities that primarily determine prognosis must be optimally treated.
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