Parameters associated with one-year mortality and in-hospital adverse events in patients after emergency pacemaker implantation.

ABSTRACT

BACKGROUND: Permanent cardiac pacing is the treatment of choice for severe and symptomatic bradycardia. Patients undergoing emergency pacemaker implantation are stabilised earlier by the insertion of a temporary emergency pacing lead, and they experience more comorbidities than with planned admissions. AIM: To identify the parameters associated with one-year mortality and in-hospital adverse events after emergency permanent pacemaker implantation. METHODS: This retrospective study analyses data from 131 consecutive emergency pacemaker implantations performed within a single centre. RESULTS: Cox regression analysis revealed the independent predictors of death to be use of a temporary transvenous pacing lead (TTPL) (HR = 2.82, 95% CI 1.21-6.58, p = 0.02), age ≥ 78 years (OR = 3.01, 95% CI 1.22-7.42, p = 0.02), longer baseline QRS duration (HR = 1.02, 95% CI 1.00-1.03, p = 0.03), and history of myocardial infarction (MI) (HR = 2.43, 95% CI 1.04-5.68, p = 0.04). Twenty-six patients experienced in-hospital adverse events, such as death (n = 6), cardiac arrest (n = 3), surgical complications (lead dislocation n = 4, haematoma n = 4, microperforation n = 2), pneumonia or respiratory tract disease (n = 7), wound infection treated with antibiotics (n = 1), and subsequent MI following pacemaker implantation (n = 2). Multivariate logistic regression analysis showed that independent parameters associated with in-hospital adverse events were history of MI (OR = 5.01, 95% CI 1.88-13.3, p = 0.001) and stroke (OR = 3.51, 95% CI 1.16-10.55, p = 0.03). CONCLUSIONS: Our results suggest that the most serious risk factors of one-year mortality related to the use of TTPL are age ≥ 78 years, longer baseline QRS duration, and history of MI. The independent parameters associated with in-hospital adverse events were the presence of a history of MI and stroke.