No abstract
The preimplantation status, postimplantation morbidlty and causes of late mortality were summarized for 246 patients who underwent pacing for atrioventricular (A-V) block at the University of Michigan for the 14 years from 1961 to 1974. The survival rate at 1,s and 10 years was 88, 61 and 49 percent, respectively. Risk of death was greatest among patients with antecedent ischemic or hypertensive heart disease or congestive heart failure In the period before pacemaker implantation, patients older than 74 years at inttlal implantation and those receiving a pacemaker before 1965. Forty-two percent of the 109 deaths were related to apparent progression of underlying cardiac disease. Pacing system malfunction was a contributing documented cause of only 3 deaths. Even with permanent pacemaker implantation, patients with A-V block have a higher age-specific mortality rate than the general U.S. population. Survival improved steadily over the period of study. This change is attributed to apparent improvements in treatment of cardiovascular disease including more effective treatment of congestive heart failure and valve replacement for selected patients as well as elimination of immediate postoperative mortality.Permanent ventricular pacing has been the recognized treatment for atrioventricular (A-V) block for more than 15 years. Previous reports14 have documented the continued morbidity and mortality in patients with A-V block who have received pacemakers. This report reviews the status of such patients to determine the natural history of this disorder after permanent pacemaker implantation, the causes of late morbidity and mortality and the changes in mortality that occurred during the follow-up period. Survival of this population group was also compared with that of the U.S. population matched for age, race and sex. Methods
One hundred and ninety patients over the age of two operated upon for coarctation of the aorta from 1957 to 1972 at one institution were followed for one to 15.5 years (mean, 6.6 years). There were eleven cardiovascular deaths in the follow-up period. The mean age at death was 32.5 years. Two-thirds of the patients had an associated cardiovascular anomaly; 74 had coexistent aortic valve disease, and 19 had mitral stenosis or insufficiency. Five patients had a significant central nervous system event in the late postoperative period. Left ventricular hypertrophy by electrocardiogram was noted in 45, and 72 had radiographic left ventricular hypertrophy. A significant persistent or residual hemodynamic abnormality, either congenital heart disease, residual coarctation or persistent diastolic hypertension, could account for the residual electrocardiographic or radiographic abnormality. The data indicate that this population requires continuing care despite correction of the coarctation.
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