Abstract：
Permanent pacemaker (PPM) implantation is a well-established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns.
Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant.
Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97-5.86, p < 0.001) on multivariable analysis.
SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.
Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant.
Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97-5.86, p < 0.001) on multivariable analysis.
SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.
摘要：
背景：永久性起搏器（PPM）植入是一种针对症状性窦房结功能障碍（SND）的完善治疗方法。这种干预的最佳时机尚不清楚，由于死亡率问题，房室传导阻滞通常在资源紧张的等待名单中优先考虑。
方法：比较接受选择性门诊（OP）PPM植入的患者的死亡率数据，以及那些因症状SND而到医院接受紧急住院(IP)管理的人。使用Kaplan-Meier图进行生存分析,并使用对数秩检验进行比较。单变量和多变量Cox回归，我们进行了倾向评分匹配分析,以评估对住院患者植入物30日和1年全因死亡率的预后影响.
结果：在1269名患有孤立性SND的患者中，740例（58%）的PPM在OP上植入，529例（42%）的PPM在IP基础上植入。在多变量分析中，患者的死亡率明显更差，患者的管理由紧急入院驱动（Log-Rankχ2=21.6，p<0.001），并且仍然是1年全因死亡率的独立预测因子（HR3.40，95％CI1.97-5.86，p<0.001）。
结论：SND主要是一种与老龄化和共病人群相关的疾病，在避免取消管制的地方，住院获得性感染，和复方是有利的。因此，避免录取是可取的策略。
方法：比较接受选择性门诊（OP）PPM植入的患者的死亡率数据，以及那些因症状SND而到医院接受紧急住院(IP)管理的人。使用Kaplan-Meier图进行生存分析,并使用对数秩检验进行比较。单变量和多变量Cox回归，我们进行了倾向评分匹配分析,以评估对住院患者植入物30日和1年全因死亡率的预后影响.
结果：在1269名患有孤立性SND的患者中，740例（58%）的PPM在OP上植入，529例（42%）的PPM在IP基础上植入。在多变量分析中，患者的死亡率明显更差，患者的管理由紧急入院驱动（Log-Rankχ2=21.6，p<0.001），并且仍然是1年全因死亡率的独立预测因子（HR3.40，95％CI1.97-5.86，p<0.001）。
结论：SND主要是一种与老龄化和共病人群相关的疾病，在避免取消管制的地方，住院获得性感染，和复方是有利的。因此，避免录取是可取的策略。
