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Impact of a poor functional capacity on the clinical outcomes in patients with a pacemaker implantation --Results from the Japanese Heart Rhythm Society Registry --
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  • Takanori Arimoto,
  • Eiichi Watanabe,
  • Ritsuko Kohno,
  • Kenji Shimeno,
  • Kan Kikuchi,
  • Atsushi Doi,
  • Kanki Inoue,
  • Takashi Nitta,
  • Akihiko Nogami,
  • Haruhiko Abe,
  • Ken Okumura
Takanori Arimoto
Yamagata University School of Medicine
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Eiichi Watanabe
Fujita Health University Bantane Hospital
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Ritsuko Kohno
University of Occupational and Environmental Health
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Kenji Shimeno
Osaka City General Hospital
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Kan Kikuchi
Japan Community Healthcare Organization Kyushu Hospital
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Atsushi Doi
University Graduate School of Medicine
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Kanki Inoue
Sakakibara Heart Institute
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Takashi Nitta
Nippon Medical School
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Akihiko Nogami
Faculty of Medicine University of Tsukuba
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Haruhiko Abe
University of Occupational and Environmental Health, Japan
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Ken Okumura
Saiseikai Kumamoto Hospital
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Abstract

Introduction: To know whether cardiac pacemaker implantations improve the functional capacity (FC) and affect the prognosis. Methods and Results: We prospectively enrolled 621 de-novo pacemaker recipients (age 76±9 years, 50.7% male) between April 2015 and September 2016. The FC was assessed by the metabolic equivalents (METs) during the implantation and periodically thereafter. The patients were a priori classified into a poor FC (<2 METs, n=40 [6.4%]), moderate FC (24 METs, n=342 [55.1%]). Three months after the pacemaker implantation, poor FC or moderate FC patients improved to a good FC by 43%. The distribution of the three FCs remained at those levels by the end of the follow-up (p=0.18). During a median follow-up of 2.4 years, 71 patients (11%) had cardiovascular hospitalizations and 35 (5.6%) all-cause death. A multivariate Cox analysis revealed that a poor FC at baseline was an independent predictor of both a cardiovascular hospitalization (hazard ratio [HR] 2.494, 95% confidence interval [CI] 1.227-5.070, p=0.012) and all-cause death (HR 3.338, 95% CI 1.254-8.886, p=0.016). One year after the pacemaker implantation, the 19 patients whose poor FC improved to a good FC did not die, however, the 8 who remained with a poor FC had a high mortality rate of 37.5% (p<0.01). Conclusion: Approximately half of the poor or moderate FC patients improved to a good FC 3 months after the pacemaker implantation. The baseline FC predicted the prognosis, and patients with an improved FC after the pacemaker implantation had a better prognosis.