Background and Objectives: Inflammatory and nutritional impairment may contribute to adverse outcomes after permanent pacemaker implantation, but their prognostic value in degenerative complete atrioventricular block remains unclear. We evaluated the association between routinely available inflammatory and nutritional indices and long-term all-cause mortality in this population. Materials and Methods: This retrospective single-center study included 272 patients who underwent permanent pacemaker implantation for isolated complete atrioventricular block attributed to degenerative conduction system disease between August 2020 and July 2024. Baseline laboratory values were used to calculate the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value. The primary endpoint was all-cause mortality during follow-up. Discriminatory performance was assessed by ROC analysis, and independent predictors were evaluated using multivariable Cox regression. Results: During a mean follow-up of 27.8 ± 16.6 months, 69 patients (25.4%) died. Non-survivors were older and had lower hemoglobin, lymphocyte count, albumin, estimated glomerular filtration rate, GNRI, LMR, and PNI, whereas C-reactive protein, NLR, and SIRI were higher. PNI showed the highest discriminative ability for mortality prediction (AUC 0.720, 95% CI 0.648-0.793; p< 0.001), exceeding albumin, lymphocyte count, GNRI, and other inflammatory indices. In multivariable Cox regression, PNI remained independently associated with mortality (HR 0.945, 95% CI 0.909-0.983; p=0.004). Single-chamber pacemaker implantation was also associated with all-cause mortality (HR 2.137, 95% CI 1.202-3.802; p=0.010), although this should be interpreted in the context of baseline vulnerability and device-selection patterns. Conclusions: PNI may provide useful prognostic information for mortality risk stratification in patients undergoing permanent pacemaker implantation for degenerative complete atrioventricular block.

Background and Objectives: Systemic inflammation and nutritional impairment may influence outcomes after permanent pacemaker implantation, but the prognostic value of composite indices in degenerative complete atrioventricular block remains unclear. We evaluated the associations of routinely available inflammatory and nutritional indices with long-term all-cause mortality in this population. Materials and Methods: This retrospective, single-center study included 272 patients who underwent permanent pacemaker implantation for isolated complete atrioventricular block attributed to degenerative conduction system disease between August 2020 and July 2024. Baseline laboratory values were used to calculate the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value. The primary endpoint was all-cause mortality during follow-up. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis, and independent associations were evaluated using multivariable Cox regression. Results: During a mean follow-up of 27.8 ± 16.6 months, 69 patients (25.4%) died. Compared with survivors, non-survivors were older and had lower hemoglobin, lymphocyte count, albumin, estimated glomerular filtration rate, GNRI, LMR, and PNI values, whereas C-reactive protein, NLR, and SIRI values were higher. PNI had the numerically highest AUC for mortality prediction (AUC: 0.720, 95% CI: 0.648–0.793; p < 0.001), corresponding to moderate discriminatory performance, whereas GNRI showed fair discrimination (AUC: 0.677, 95% CI: 0.589–0.766; p < 0.001). In multivariable Cox regression, PNI remained independently associated with mortality (HR: 0.945, 95% CI: 0.909–0.982; p = 0.004). Conclusions: Among the evaluated inflammatory and nutritional indices, PNI demonstrated the numerically highest discriminatory performance and remained independently associated with long-term all-cause mortality. PNI may therefore serve as a readily available adjunct to clinical risk stratification in patients undergoing permanent pacemaker implantation for degenerative complete atrioventricular block; however, external validation is required.