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Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction

Roman Brenner, Peter Ammann, See-Il Yoon, Stefan Christen, Jens Hellermann, Grégoire Girod, Urs Knaus, Firat Duru, Nazmi Krasniqi, David Ramsay, Christian Sticherling, Kurt Lippuner & Michael Kühne

abstract

Aims
Elderly patients with sinus node dysfunction (SND) are at increased risk of falls with possible injuries. However, the incidence of these adverse events and its reduction after permanent pacemaker (PPM) implantation are not known.

Methods and results
Eighty-seven patients (mean [SD] age 75.4 [8.3] years, 51% women) with SND and an indication for cardiac pacing were included and were examined by a standardized interview targeting fall history. The incidence and total number of falls, falls with injury, falls requiring treatment, and falls resulting in a fracture were assessed for the time period of 12 months before (retrospectively) and after PPM implantation (prospectively). Furthermore, symptoms such as syncope, dizziness, and dyspnea were evaluated before and after PPM implantation. The implantation of a PPM was associated with a reduced proportion of patients experiencing at least one fall by 71% (from 53 to 15%, P < 0.001) and a reduction of the absolute number of falls by 90% (from 127 to 13, P < 0.001) during the 12 months before vs. after PPM implant. Falls with injury (28 vs. 10%, P = 0.005), falls requiring medical attention (31 vs. 8%, P < 0.001), and falls leading to fracture (8 vs. 0%, P = 0.013) were similarly reduced. Notably, fewer patients had syncope (4 vs. 45%, P < 0.001) and dizziness after PPM implantation (12 vs. 45%, P < 0.001).

Conclusion
Falls, fall-related injuries, and fall-related fractures are frequent in SND patients. Permanent pacemaker implantation is associated with a significantly reduced risk of these adverse events, although no causal relationship could be established due to the study design.
   
citation Brenner R, Ammann P, Yoon S I, Christen S, Hellermann J, Girod G, Knaus U, Duru F, Krasniqi N, Ramsay D, Sticherling C, Lippuner K, Kühne M. Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction. Europace 2017; 19:1220-1226.
   
type journal paper/review (English)
date of publishing 01-7-2017
journal title Europace (19/7)
ISSN electronic 1532-2092
pages 1220-1226
PubMed 27702858
DOI 10.1093/europace/euw156