Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie

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• 作者：Laurent Fauchier^a ; ^{lfau@med.univ-tours.fr" class="auth_mail" title="E-mail the corresponding author} ; Christine Alonso^b ; Frederic Anselme^c ; Hugues Blangy^d ; Pierre Bordachar^e ; Serge Boveda^f ; Nicolas Clementy^a ; Pascal Defaye^g ; Jean-Claude Deharo^h ; Patrick Friocourtⁱ ; Daniel Gras^j ; Franck Halimi^k ; Didier Klug^l ; Jacques Mansourati^m ; Benjamin Obadia^h ; Jean-Luc Pasquié ; ⁿ ; Dominique Pavin^o ; Nicolas Sadoul^d ; Jerome Taieb^p ; Olivier Piot^q ; Olivier Hanon^r
• 关键词：Cardiac pacing ; Implantable cardioverter defibrillator ; Cardiac resynchronization therapy ; Elderly
• 刊名：Archives of Cardiovascular Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：109
• 期：10
• 页码：563-585
• 全文大小：2269 K

文摘

Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5–7 years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients.