The prognosis of patients over 75 years old receiving a pacemaker in the context of sinus-node dysfunction is unclear.

This study sought to evaluate the incidences of atrial fibrillation (AF), heart failure (HF) and death in this population and the role of the pacing mode in their prognosis.

This was a retrospective study on 102 patients over 75 years old (mean 82.2 ± 8.6 years) who received a pacemaker in the context of sinus-node dysfunction.

During the follow-up period (mean: 806 days), 36 patients (35.3%) experienced HF and 47 patients (46.1%) an episode of paroxysmal AF, 19 patients (18.6%) progressed to chronic AF, and 29 (28.4%) died, the fatal event being sudden death or of cardiac origin in almost half these patients (44.8%). Patients assigned to dual-chamber minimal ventricular pacing showed a significantly lower rate of HF episodes (p = 0.023), and a lower all-cause mortality (p<0.001) than those assigned to conventional dual-chamber pacing. In contrast, the two groups did not differ with regard to either paroxysmal or chronic AF, regardless of whether or not the algorithms designed to prevent AF were activated.

In patients with a high risk of mortality and morbidity, the use of dual-chamber pacemakers incorporating an algorithm minimizing ventricular pacing seems to decrease the number of HF episodes and mortality. On the basis of this finding, the implantation of such devices even in this age group seems justifiable.