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. 2020 Dec 9;37(1):182-188.
doi: 10.1002/joa3.12459. eCollection 2021 Feb.

Impact of a poor functional capacity on the clinical outcomes in patients with a pacemaker implantation -Results from the Japanese Heart Rhythm Society Registry

Takanori Arimoto  1 , Eiichi Watanabe  2 , Ritsuko Kohno  3 , Kenji Shimeno  4 , Kan Kikuchi  5 , Atsushi Doi  6 , Kanki Inoue  7 , Takashi Nitta  8 , Akihiko Nogami  9 , Haruhiko Abe  3 , Ken Okumura  10
Affiliations

Impact of a poor functional capacity on the clinical outcomes in patients with a pacemaker implantation -Results from the Japanese Heart Rhythm Society Registry

Takanori Arimoto et al. J Arrhythm. .

Abstract

Background: Functional capacity (FC) correlates with mortality in various cardiovascular diseases. The aim of this study was to examine whether cardiac pacemaker implantations improve the FC and affect the prognosis.

Methods and results: We prospectively enrolled 621 de novo pacemaker recipients (age 76 ± 9 years, 50.7% male). The FC was assessed by metabolic equivalents (METs) during the implantation and periodically thereafter. The patients were a priori classified into poor FC (<2 METs, n = 40), moderate FC (2 ≤ METs < 4, n = 239), and good FC (≥4 METs, n = 342). 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 until after 1 year of follow-up (P = .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 cardiovascular hospitalization (hazard ratio [HR] 2.494, P = .012) and all-cause death (HR 3.338, P = .016). One year after the pacemaker implantation, the eight who remained with a poor FC had a high mortality rate of 37.5% (P < .01).

Conclusion: Approximately half of the poor or moderate FC patients improved to 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.

Keywords: functional capacity; pacemaker; prognosis.

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Conflict of interest statement

EW received a lecture fee from Biotronik Japan, Daiichi‐Sankyo, and Pfizer. RK has an affiliation with the endowed departments of Boston Scientific and Abbott. AN received a lecture fee from Daiichi‐Sankyo and has an affiliation with the endowed department of Boston Scientific and Abbott. KO received a lecture fee from Johnson and Johnson, Medtronic, Daiichi‐Sankyo, and Boehringer‐Ingelheim. None of the other authors have conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The time course of the functional capacity (FC). (A) Changes in the FC between baseline and 3 months after the pacemaker implantation. Three months after the pacemaker implantation, 43% of those with poor and moderate FC at baseline improved to good FC (16 + 105/40 + 239). During the 3 months follow‐up period, 78 patients were lost because they returned to the hospital or clinic that had been referred after the device implantation. (B) The raw number of FCs during follow‐up. (C) The proportion of three classes of FCs. The patients were a priori classified into poor FC (<2 METs), moderate FC (2 ≤ METs <4), and good FC (≥4 METs). FC = functional capacity, F/U = follow‐up, METs = metabolic equivalents
FIGURE 2
FIGURE 2
Kaplan‐Meier analysis of the time to the subsequent outcome. (A) The cardiovascular hospitalization rate was higher in the patients with poor FC than in those with moderate or good FC. (B) The total mortality rate was higher in the patients with poor FC than in those with moderate FC or good FC. Abbreviations are shown in Figure 1
FIGURE 3
FIGURE 3
Subgroup analysis among the patients with poor functional capacity. (A) Changes in the functional capacity during 1‐year follow‐up. Seven (17.5%) patients improved to moderate FC, and 19 (47.5%) had a marked improvement. Abbreviations are shown in Figure 1. (B) The total mortality rates. A log‐rank test was not applied because no patients with good FC died
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