Prognosis of patients with implanted pacemakers in 4‑year follow-up: Impact of right ventricular pacing site

BACKGROUND: Pacing remains the method of choice for treatment of cardiac electrical conduction disorders. This study examined the interrelationship between the site of the right ventricular lead tip and patient prognosis in association with other cardiovascular risk factors over a 4‑year follow-up period. PATIENTS AND METHODS: The study comprised 450 consecutive patients (223 women; aged 69.16 ± 9.63 years) who had their first SSI or DDD pacemaker implanted for typical indications. RESULTS: During follow-up, 91 (20.2%) patients died. The positive prognostic factors were: female sex (hazard ratio [HR] = 0.426), DDD pacemaker (HR = 0.526), oral anticoagulant use (HR = 0.330; all groups), sodium concentration (HR = 0.926), oral anticoagulant (HR = 0.115) and statin (HR = 0.260) use (female group), and non-apical location of the right ventricular lead tip (HR = 0.549; male group). Risk factors for death were: age (HR = 1.063), diabetes requiring insulin (HR = 2.832), creatinine concentration (HR = 1.005; all groups), age (HR = 1.11; female group), and elevated creatinine level (HR = 1.012; male group). In all patients, the non-apical location of the right ventricular lead tip was associated with an 18.92% reduced mortality rate during the 4‑year follow-up, which was statistically significant for the male group. CONCLUSION: The non-apical location of the right ventricular lead tip was a positive prognostic factor and was statistically significant in the male subgroup.