ABSTRACT
Background: According to the Italian National Statistical Institute, the 12- month probability of survival in the general population between 90 and 94 years-old is 26%. Pacemaker (PM) implantation is often an urgent and necessary intervention, but in these patients the benefit in terms of quality and duration of life is unclear. Purpose(s): To analyze characteristics, outcome and factors associated with survival in patients who had turned 90 at the time of PM implant. Method(s): All the PM implants performed in patients >=90 from 1/1/2019 to 12/31/2020 were analyzed. Clinical parameters, device characteristics and follow-up data were extrapolated from the SuitEstensa Ebit reporting system;the exitus was verified by analyzing data from the Regional Health System. Result(s): During the study interval, among the 554 patients undergoing PM implantation in our Center, 69 (12%) were >=90 years-old (mean age 92+/-2 years, 46% male;complete/advanced AV block in 76%). Twenty-six (38%) patients had history of atrial fibrillation and 19 (28%) ischemic heart disease. A cardiological co-morbidity (excluding AF) was present in 23 patients (33%). Oncological, pneumological and neurological comorbidities were present in 12 (18%), 19 (28%) and 32 (46%) respectively. Renal impairment was present in 25 patients (36%). In 47 patients (68%) there were at least 2 co-morbidities. After implantation (single-chamber in 36, dualchamber in 25 and VDD single-lead dual-chamber in 8 patients) complications occurred in 3 patients (2 pneumothorax and 1 lead dislodgment). Remote monitoring was activated in 57 patients (83%). Within August 31st 2021 (mean follow-up 288+/-193 days) 24 patients died (35%, 219+/-241 days after implant). Five patients (19% of patients implanted in 2019) died within 12 months. No patients died for device malfunction. Three patients died because of COVID-19 pneumonia. Renal dysfunction (Hazard Ratio-HR 8.05, p=0.002) and the presence of 2 or more co-morbidities (HR 6.03;p=0.015) were associated with a higher risk of death at univariate analysis;other significant variables were diabetes (HR 2.34;p=0.038), left ventricular ejection fraction (LVEF) (HR 0.70 for 5% variation;p=0.005), walking impairment (HR 2.99, p=0.006), the presence of oncological (HR 2.21;p=0.003), pneumological (HR 2.55;p=0.024) and neurological (HR 1.90, p=0.007) comorbidities. At multivariable analysis the only significant parameter associated with survival was LVEF (0.76 for 5% difference;p=0.043) Conclusion(s): At our Center, patients >=90 years-old undergo PM implantation mainly for advanced AVB. The good survival in the medium term, even better than expected in the general population, does not justify a too conservative attitude especially, but exclusively, in patients with less comorbidities.
ABSTRACT
Introduction: Among all western countries, Italy was the first to be strongly affected by COVID-19 pandemic, and one of the first to apply the “hard” lockdown. In order to limit the in-hospital infections and to re-distribute the healthcare professionals, all healthcare elective activities were reduced or cancelled, and among them, cardiac percutaneous interventions in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergent ones. The aim of this paper is to describe the impact of COVID-19 pandemic on Pediatric and ACHD cath lab activity during the so called “hard lockdown” in Italy. Methods: On behalf of the interventional working group of the Italian Society of Pediatric Cardiology, 11 out of 12 Italian Institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated to the survey. The institutions were distributed over all the national territory, 5 in the northern regions, 3 in the central and 3 in the southern ones. The data from each center were collected using a self-completion questionnaire containing 41 multiple choices questions. Results: Most of the hospitals were affected by the COVID-19 pandemic, either actively, with direct management of infected patients, or passively due to decrease of routinely clinical activities. The majority of institutions stated a change in the cath lab usual workflow plan and accessibility. Most of the centers had to cease at least temporarily the Cath lab practice, and the overall reduction of procedures number ranged between 50% and 75%. This reduction was more pronounced for teenagers and ACHD compared to neonates and children. Interestingly, there was an evident discrepancy in the management of the lock-down, irrespective of the number of COVID-19 positive cases registered, with higher reduction in Southern Italy compared to the most affected Regions Conclusions: COVID-19 pandemic has significantly affected the activity of 11 different pediatric cardiology and ACHD units all over Italy. Cath lab services were deeply impacted due to decline in outpatient clinic consultations and referrals from local hospitals. ACHD cath lab procedures suffered the biggest drop. However, overall activity reduction was not consistent with the severity of outbreak in the different Italian regions.