Trend in Age at the Initial Pacemaker Implantation in Patients With Bradyarrhythmia-A 50-Year Analysis (1970-2019) in Japan

Background: This study investigated whether the age of patients undergoing pacemaker implantation is increasing. Methods and Results: This study retrospectively reviewed the consecutive cases of 3,582 patients who underwent an initial pace-maker implantation at our hospitals because of symptomatic bradyarrhythmias between 1970 and 2019. The exclusion criteria were: patients with AV block due to cardiac surgery or AV junction ablation, and patients aged <20 years. The patients were divided into 5x10-year groups: those treated in the 1970s (1970-1979), 1980s (1980-1989), 1990s (1990-1999), 2000s (2000-2009), and 2010s (2010-2019). A total of 3,395 patients satisfied the study criteria. The average age at which the patients underwent a first pacemaker implantation increased across the 10-year periods: 63.7 +/- 13.2 years in the 1970s, 66.2 +/- 12.6 years (1980s), 69.1 +/- 12.4 years (1990s), 72.0 +/- 11.1 years (2000s), and 75.8 +/- 10.0 years (2010s) and advanced significantly in the 1990s, 2000s, and 2010s compared to the 1970s (all P<0.001). The ratio of patients aged >= 80 and >= 90 years increased from 10.6% and 0% in the 1970 s to 38.2% (P<0.001) and 5.2% (P= 0.017) in the 2010s, respectively. Conclusions: The average age at initial pacemaker implantation increased by 12.1 years over the last 50 years in Japan. In par-ticular, the ratios of >= 80 and >= 90 years as the patients age increased significantly.