Introduction
Methods
Study population
Statistical analysis
All patients | Pacing dependency | P value | ||
---|---|---|---|---|
Clinical variable | n = 786 | Yes (n = 130) | No (n = 656) | |
Age, years | 74 ± 13 | 75 ± 12 | 74 ± 13 | 0.30 |
Male gender, n (%) | 512 (65) | 88 (68) | 424 (65) | 0.57 |
Arterial hypertension, n (%) | 612 (78) | 104 (80) | 508 (77) | 0.52 |
Diabetes mellitus, n (%) | 142 (18) | 19 (15) | 123 (19) | 0.32 |
Atrial fibrillation before implant, n (%) | 238 (30) | 37 (28) | 201 (31) | 0.70 |
Chronic kidney disease, n (%) | 326 (41) | 69 (53) | 257 (39) | < 0.01 |
Heart failure severity | ||||
Left ventricular ejection fraction, % | 43 ± 13 | 40 ± 12 | 44 ± 13 | < 0.01 |
Left ventricular ejection fraction ≤ 30%, n | 175 (22) | 40 (31) | 135 (21) | 0.01 |
NYHA functional class III or IV, n | 314 (40) | 73 (56) | 241 (37) | < 0.01 |
Underlying cardiac disease, n (%) | ||||
Coronary artery disease | 310 (39) | 45 (35) | 265 (40) | 0.22 |
Nonischemic dilated cardiomyopathy | 115 (15) | 25 (19) | 90 (14) | 0.14 |
Hypertensive heart disease | 176 (22) | 35 (27) | 141 (21) | 0.18 |
Valvular heart disease | 100 (13) | 17 (13) | 83 (13) | 0.89 |
Other cardiac diseases a | 12 (2) | 4 (3) | 8 (1) | 0.24 |
No structural heart disease | 73 (9) | 4 (3) | 69 (11) | 0.01 |
Previous cardiac surgery, n (%) | ||||
Aortocoronary bypass grafting | 95 (12) | 17 (13) | 78 (12) | 0.82 |
Surgical aortic valve replacement | 29 (4) | 4 (3) | 25 (4) | 0.88 |
Transcatheter aortic-valve replacement, n (%) | 43 (5) | 9 (7) | 34 (5) | 0.56 |
Cardiovascular implantable electronic device, n (%) | ||||
Antibradycardia pacemaker | 555 (71) | 103 (79) | 452 (69) | 0.02 |
Implantable cardioverter-defibrillator | 231 (29) | 27 (21) | 204 (31) | |
Cardiac resynchronisation therapy device | 92 (12) | 28 (22) | 64 (10) | 0.01 |
Indication for CIED implantation, n (%) | ||||
Sick sinus syndrome | 191 (24) | 12 (9) | 179 (27) | < 0.01 |
Second or third-degree AV block | 244 (31) | 95 (73) | 149 (23) | < 0.01 |
Atrial fibrillation with bradycardia | 124 (16) | 14(11) | 110 (17) | 0.11 |
Carotid sinus syndrome | 1 (0.1) | 0 (0) | 1 (0.2) | 0.66 |
Prophylactic b | 226 (29) | 9 (7) | 217 (33) | < 0.01 |
Amount of ventricular pacing, % | 46 ± 30 | 98 ± 12 | 36 ± 41 | < 0.01 |
Medication | ||||
β‑Blockers | 530 (67) | 84 (65) | 446 (68) | 0.45 |
ACE inhibitors or ARBs | 580 (74) | 101 (77) | 479 (73) | 0.32 |
Diuretics | 538 (68) | 99 (76) | 439 (67) | 0.04 |
Aldosterone antagonists | 219 (28) | 27 (21) | 192 (29) | 0.06 |
Angiotensin-neprilysin inhibitor | 25 (3) | 1 (1) | 24 (4) | 0.15 |
All patients | Death during follow-up | Univariate regression analysis | |||
---|---|---|---|---|---|
Clinical variable | n = 786 | Yes (n = 304) | No (n = 482) | P value | HR (95% CI) |
Pacing dependency, n (%) | 130 (17) | 63 (21) | 67 (14) | 0.04 | 1.35 (1.02–1.78) |
Amount of ventricular pacing, % | 46 ± 30 | 55 ± 43 | 41 ± 44 | < 0.01 | 1.01 (1.00–1.01) |
Age, years | 74 ± 13 | 80 ± 8 | 70 ± 14 | < 0.01 | 1.08 (1.06–1.09) |
Male gender, n (%) | 512 (65) | 126 (41) | 326 (68) | 0.02 | 0.76 (0.61–0.93) |
Arterial hypertension, n (%) | 612 (78) | 270 (89) | 342 (71) | < 0.01 | 2.52 (1.78–3.60) |
Diabetes mellitus, n (%) | 142 (18) | 63 (21) | 79 (16) | 0.21 | 1.20 (0.91–1.60) |
Atrial fibrillation before implant, n (%) | 238 (30) | 127 (42) | 111 (23) | < 0.01 | 2.02 (1.61–2.54) |
Chronic kidney disease, n (%) | 326 (41) | 173 (57) | 153 (32) | < 0.01 | 2.67 (1.81–2.85) |
Heart failure severity | |||||
Left ventricular ejection fraction ≤ 30% | 175 (22) | 86 (28) | 89 (18) | < 0.01 | 1.44 (1.12–1.85) |
NYHA functional class III or IV | 314 (40) | 181 (60) | 133 (28) | < 0.01 | 2.75 (2.12–3.46) |
Underlying cardiac disease, n (%) | |||||
Coronary artery disease | 310 (39) | 139 (46) | 171 (35) | 0.02 | 1.30 (1.04–1.63) |
Nonischemic dilated cardiomyopathy | 115 (15) | 27 (9) | 88 (18) | < 0.01 | 0.51 (0.34–0.76) |
Hypertensive heart disease | 176 (22) | 77 (25) | 99 (21) | 0.13 | 1.22 (0.94–1.56) |
Valvular heart disease | 100 (13) | 44 (14) | 56 (12) | 0.20 | 1.23 (0.89–1.70) |
Other cardiac diseases | 12 (2) | 2 (1) | 10 (2) | 0.23 | 0.43 (0.11–1.72) |
No structural heart disease | 73 (9) | 15 (5) | 58 (12) | < 0.01 | 0.50 (0.30–0.85) |
Previous cardiac surgery, n (%) | |||||
Aortocoronary bypass grafting | 95 (12) | 41 (13) | 54 (11) | 0.48 | 1.13 (0.81–1.56) |
Surgical aortic valve replacement | 29 (4) | 8 (3) | 21 (4) | 0.24 | 0.65 (0.32–1.32) |
Transcatheter aortic-valve replacement | 43 (5) | 20 (7) | 23 (5) | 0.19 | 1.36 (0.86–2.14) |
Cardiovascular implantable electronic device, n (%) | |||||
Antibradycardia pacemaker | 555 (71) | 230 (76) | 325 (67) | 0.02 | 1.37 (1.05–1.78) |
Implantable cardioverter-defibrillator | 231 (29) | 74 (24) | 157 (33) | 0.02 | 0.73 (0.56–0.95) |
Cardiac resynchronisation therapy device | 92 (12) | 39 (13) | 53 (11) | 0.63 | 1.09 (0.78–1.52) |
Indication for CIED implantation, n (%) | |||||
Sick sinus syndrome | 191 (24) | 74 (24) | 117 (24) | 0.71 | 1.05 (0.81–1.37) |
Second or third-degree AV block | 244 (31) | 95 (31) | 149 (31) | 0.63 | 0.94 (0.74–1.20) |
Atrial fibrillation with bradycardia | 124 (16) | 68 (22) | 56 (12) | < 0.01 | 1.78 (1.36–2.33) |
Carotid sinus syndrome | 1 (0.1) | 0 (0) | 1 (0.2) | 0.64 | – |
Prophylactic a | 226 (29) | 67 (22) | 159 (33) | < 0.01 | 0.66 (0.50–0.86) |
Medication, n (%) | |||||
β‑Blockers | 530 (67) | 217 (71) | 313 (65) | 0.03 | 1.32 (1.03–1.70) |
ACE inhibitors or ARBs | 580 (74) | 213 (70) | 367 (76) | 0.02 | 0.74 (0.58–0.94) |
Diuretics | 538 (68) | 248 (82) | 290 (60) | < 0.01 | 2.35 (1.76–3.14) |
Aldosterone antagonists | 219 (28) | 85 (28) | 134 (28) | 0.94 | 1.01 (0.79–1.30) |
Angiotensin-neprilysin inhibitor | 25 (3) | 11 (4) | 14 (3) | 0.54 | 1.21 (0.66–2.21) |
Results
Clinical characteristics
Predictors of all-cause mortality during follow-up
All patients | Death during follow-up | Multivariate Cox analysis | |||
---|---|---|---|---|---|
Clinical variable | n = 786 | Yes (n = 304) | No (n = 482) | P value | HR (95% CI) |
Pacing dependency, n (%) | 130 (17) | 63 (21) | 67 (14) | 0.35 | 1.15 (0.86–1.54) |
Age, years | 74 ± 13 | 80 ± 8 | 70 ± 14 | < 0.01 | 1.07 (1.05–1.08) |
History of atrial fibrillation, n (%) | 238 (30) | 127 (42) | 111 (23) | 0.026 | 1.32 (1.03–1.69) |
Chronic kidney disease, n (%) | 326 (41) | 173 (57) | 153 (32) | 0.048 | 1.28 (1.00–1.63) |
NYHA functional class III or IV | 314 (40) | 181 (60) | 133 (28) | < 0.01 | 2.00 (1.52–2.62) |