25/2012 - Uniwersytet Jana Kochanowskiego w Kielcach

ANALYSIS OF PATIENT SURVIVAL AFTER PERMANENT PACEMAKER IMPLANTATION AT THE ŚWIĘTOKRZYSKIE CARDIAC CENTER IN KIELCE
The Świętokrzyskie Cardiac Center in Kielce performs
the largest number of implantation procedures.
This professional institution with two operators was
established in 1993 implanting 52 pacemakers in the
first year. With the increasing experience the number
of implanted devices was also increasing and there
were more and more operators. Eighteen years ago
a department of pacemaker checkups was simultaneously
established. In 2005 we started to implant
cardioverter-defibrillators and cardiac resynchronization
therapy devices. By the end of 2010 we had
implanted over 8000 new pacemakers and replaced
another 1200. Annually we check up about 4000
pacemakers.
The present paper contains data regarding the
numbers of implanted pacemakers in the Ward of
Cardiology at the Świętokrzyskie Cardiac Center in
Kielce in 1993–2009. The aim of the study is to provide
a preliminary analysis of survival among patients
after permanent pacemaker implantation.
MATERIAL AND METHODS
We analyzed 7482 patients with permanent pacemakers
implanted at the Świętokrzyskie Cardiac
Center in Kielce between 1993 and 2009. All the
patients were registered in the Department of Pacemaker
Checkups. We analyzed pacemaker data and
when necessary patient medical records. Information
about death was obtained from the Department of
Vital Records in Kielce.
Survival probabilities in patients with pacemakers
were analyzed using the Kaplan-Meyer
method. Survival curves were calculated for men and
women sepa rately and for the entire group. Analysis
comprised patients up to 80 years of age because of
the natural and strong tendency towards increased
mortality with increasing age. Gehan’s modified
Wilcoxon test was used to test for the significance of
differences between groups of patients with different
types of pacemakers.
RESULTS
Altogether we implanted 787 (10.5%) AAI/R,
4031 (54.0%) VVI/R, 465 (6.2%) VDD/R and 2199
(29.4%) DDD/R pacemakers and performed another
1093 replacements (table 2). In the recent years the
number of implanted new devices has reached a stable
level of 660–680 annually. The number of replacements
increased to about 150–180 annually (table 3).
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Characteristics of patients with different types of
pacemakers are summarized in table 2. The mean age
was 71.8 ± 12.9 years. There were 51.2% of women.
The largest number of pacemakers was implanted
in patients aged 71–80 years in contrast to those aged
18–20 years (fig. 1).
Analysis of survival probability after permanent
pacemaker implantation was performed separately for
men and women and for the entire group.
In our study there were significant differences
between groups with VVI/R and DDD/R, between
VVI/R and AAI/R and between VVI/R and VDD/R
pacing. The highest and the lowest probability of survival
was found in patients with VDD/R and VVI/R
devices, respectively (fig. 2).
Similar results were found in men and women
separately (figs. 3 and 4).
Table 2. Characteristics of patients with pacemakers implanted
at the Świętokrzyskie Cardiac Center in 1993–2009
Patients
Mean age
(years ± SD)
Number of
patients > 80
years of age
Female
gender
Rural
inhabitants
Survived > 5
years
Deaths
during
follow-up
With
AAI/R
n = 787
74,93 ±
9.58
96
(19.9%)
476
(60.5%)
307
(39.0%)
677
(86.0%)
118
(15.0%)
With
VVI/R
n = 4031
79,1 ±
9.5
1029
(25.5%)
2028
(56.6%)
2125
(52.7)
2644
(65.6%)
1431
(35.5%)
With
VDD/R
n = 465
70,62 ±
12.72
65
(14.0%)
195
(41.9%)
209
(44.9%)
369
(79.4%)
65
(13.9%)
With
DDD/R
n = 2199
72,97 ±
10.76
281
(12.8%)
1130
(51.4%)
943
(42.9%)
1760
(80.0%)
354
(16.1%)
Total
N =
7482
76,32 ±
10.58
1471
(19.7%)
3829
(51.2%)
3584
(47.9%)
5450
(72.8%)
1968
(26.3%)
Table 3. Pacemaker replacements at the Świętokrzyskie Cardiac
Center in 1993–2009
Years Number of replacements
1993–1998 62
1999–2002 140
2003–2004 198
2005 117
2006 53
2007 187
2008 148
2009 188