Opinions please on pacemaker 87 year old

[Patty]

Our friend who is like my husband adopted my is 87 years old.She does has some medical problems high blood pressure and diabtes2 and heart problems. She got real dizzy yesterday and ended up in the Er well they put her in the heart hospital her pulse was really low. They want to put a pacemaker in she feels she doesn't have long to live so it can't hurt getting one. She was in the hospital last year for pnemonia and was in there for 4 weeks. I am trying to do research to see about putting in a pacemaker at her age any input would be nice to have.My concern is because she has been so frail lately but to me it is her decision she is still very active with her mind.

[bobtisoy]

Hello Patty,

I wish your friend the best of health always.:p

Indications for implantation of a permanent pacemaker in the elderly are generally based on symptoms, the presence of heart disease and the presence of symptomatic bradyarrhythmias. Pacemakers for tachyarrhythmias, cardioversion and defibrillation are also available. Gregoratos reviews current indications for pacemaker use and advances in technology.
Patients more than 70 years of age account for greater than 70 percent of pacemakers implanted, in part. This is due to the physiologic changes that occur with aging, in which the heart's conduction system becomes disordered. Specifically, there is a reduction in P cells and an increase in collagen in the sinoatrial node. The number of conduction cells in the bundle of His and in the bundle branches also decrease. Hemodynamic compromise is more common in the elderly when these physiologic changes cause arrhythmias. The American College of Cardiology/ American Heart Association recently issued practice guidelines outlining the indications for permanent pacing. One of the main tenets is that symptoms need to be correlated with the arrhythmia before pacing is initiated. Many types of pacemakers are available, generally categorized by a three- to five-letter code according to the site of the pacing electrode and the mode of pacing.
Indications for Permanent Pacing in Acquired Atrioventricular Block in Adults
1. Class I Third-degree AV block at any anatomic level associated with any one of the following conditions:
1. Bradycardia with symptoms presumed to be due to AV block
2. Arrhythmias and other medical conditions that require drugs that result in symptomatic bradycardia
3. Documented periods of asystole (>= 3 seconds or any escape rate <40 bpm) in awake, symptom-free patients
4. After catheter ablation of the AV junction; there are no trials to assess outcome without pacing, and pacing is virtually always planned in this situation unless the operative procedure is AV junction modification
5. Postoperative AV block that is not expected to resolve
6. Neuromuscular diseases with AV block such as myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb's dystrophy (limb-girdle) and peroneal muscular atrophy.
2. Second-degree AV block regardless of type or site of block, with associated symptomatic bradycardia
1. Class IIa Asymptomatic third-degree AV block at any anatomic site with average awake ventricular rates of 40 bpm or faster
2. Asymptomatic type II second-degree AV block
3. Asymptomatic type I second-degree AV block at intra- or infra-His levels found incidentally at electrophysiologic study for other indications
4. First-degree AV block with symptoms of pacemaker syndrome and documented alleviation of symptoms with temporary AV pacing
1. Class IIb Marked first-degree AV block (>0.3 second) in patients with LV dysfunction and symptoms of congestive heart failure in whom a shorter AV interval results in hemodynamic improvement, presumably by decreasing left atrial filling pressure
1. Class III Asymptomatic first-degree AV block
2. Asymptomatic type I second-degree AV block at the supra-His (AV node) level or not known to be intra- or infra-Hisian
3. AV block expected to resolve and unlikely to recur (e.g., drug toxicity, Lyme disease)
AV = atrioventricular; bpm = beats per minute; LV = left ventricular.
Adapted with permission from Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol 1998;31:1175-1209.
First-degree atrioventricular (AV) block, thought to be a relatively benign arrhythmia, can be associated with severe symptoms that may benefit from permanent pacing. Specifically, some uncontrolled trials have shown a benefit from pacing in patients with a PR interval greater than 0.3 seconds. Type I second-degree AV block does not usually require permanent pacing because progression to a higher degree AV block is not common. Permanent pacing is known to improve survival in patients with complete heart block, especially if they have had syncope.
Permanent pacing is not needed in a number of conditions, even in patients with advanced AV block. Reversible causes of AV block, such as electrolyte disturbances or Lyme disease, simply require treatment of the underlying cause. In other situations, AV block occurs only sporadically, as with sarcoidosis, but should be treated with pacing because of the known history of disease progression. Implantation is typically easier and of lower cost with single-chamber ventricular demand (VVI) pacemakers, but use of these devices is becoming less common with the advent of dual-chamber demand (DDD) pacemakers. Symptoms of AV block generally resolve after insertion of a DDD pacemaker, although the prognosis is poorer in patients with severe left ventricular dysfunction and coronary heart disease.

[Patty]

bobtisoy thanks for the information I want say that I didn't get loss in all of it. I went to see my friend today she is scared her heart doctor she has had will not do it he didn't think she would make the surgery another heart doctor is going to do it he said to her what do you have to lose without it we can't say how much longer you have. She is worried because her neck artiers are clog they did that test today I don't know how much they are clog at one time I seem to recall one side was 90 percent.I am waiting to hear back from her to see what else the doctor said. Thank you so much for her well wishes.patty

[bobtisoy]

Hello Patty,

No problem, just glad I helped in a way!
I wish your friend the best of health always.:p

[Patty]

I just wanted you to know that my friend regular heart doctor would not do the pacemaker but another wonderful doctor was not giving up on her and he put in the pacemaker and she is now home from the hospital doing well and feeling spry she said.patty

[bobtisoy]

Hi Patty,

I am glad to hear that!
I wish her the best of health!:p

[dmongking]

Hi Patty,

It is a good thing that your friend decided to have the pacemaker. It will really help her.

To further assure you that age does not affect the effectivity of pacemaker, please read this link: http://europace.oxfordjournals.org/cgi/content/abstract/eun293

Good luck to your friend!