Mortality Rate of Pacemaker Implantation
Pacemaker implantation carries an in-hospital mortality rate of approximately 1.5%, with death almost never directly attributable to the procedure itself but rather to underlying comorbidities and pre-existing conditions. 1
Procedural and In-Hospital Mortality
The immediate procedural mortality is extremely low at 1.5% based on a large contemporary cohort of 5,079 patients. 1
In this cohort, death was not directly attributable to the pacemaker procedure in any patient, but instead related to:
- Non-device-related infections (28.6%)
- Heart failure (25.7%)
- Extracardiac diseases (21.4%)
- Multiorgan failure (8.6%)
- Previous resuscitation with hypoxic brain damage (8.6%)
- Arrhythmogenic death (7.1%) 1
Patients who died during hospitalization were significantly older (79.6 vs. 76.3 years), had worse ASA physical status, lower ejection fraction, and greater prevalence of high-degree AV block. 1
Perioperative complications were similar between patients who died and those who survived, reinforcing that mortality is driven by comorbidities rather than procedural factors. 1
Long-Term Mortality in Elderly Patients with CAD
For your specific patient population (elderly with AV block and CAD history), the mortality trajectory is as follows:
Short to Medium-Term Survival
- 1-year survival: 90% (10% mortality) 2, 3
- 2-year survival: 76-82% (18-24% mortality) 2, 4, 3
- 3-year survival: 54-74% (26-46% mortality) 2, 4, 3
Long-Term Survival
Critical Prognostic Factors
The following pre-implantation factors predict worse survival and should be carefully assessed:
- Renal failure (HR 1.63; 95% CI 1.15-2.31) 2
- eGFR <30 ml/min/1.73 m² (HR 4.07; 95% CI 1.95-8.52) 3
- Active malignancy (HR 1.78; 95% CI 1.27-2.51) 2
- Cerebrovascular disease (HR 1.75; 95% CI 1.25-2.46) 2
- BMI <21 kg/m² (HR 2.50; 95% CI 1.16-5.39) 3
- Longer hospital length of stay before implantation (HR 1.03 per day; 95% CI 1.02-1.05) 3
- Dyspnea as presenting symptom (HR 2.88; 95% CI 1.27-6.55) 3
Important Clinical Context
The majority of deaths (74.1%) in elderly pacemaker recipients are from non-cardiac causes, emphasizing the importance of overall health status rather than cardiac disease alone. 3
Pacemaker implantation significantly prolongs life and improves quality of life even in the most advanced age groups, with operative risk remaining low (2.5% perioperative mortality in patients aged 70-87 years). 4
For patients with complete heart block, pacing is indicated when heart rate is <50 bpm, prolonged QT interval is present, or structural heart disease exists, as these constitute risk factors for sudden cardiac death. 5
After AV nodal ablation requiring pacemaker dependence, the 1-year mortality rate is approximately 6.3%, including a 2.0% risk of sudden death. 6