Abstract
OBJECTIVE: To evaluate trends in pacemaker mode prescription from 1984 to 1994 with particular reference to the changes in pacemaker mode prescription for patients aged 80 years and older at implant. DESIGN: Prospective evaluation of indications for pacing and pacemaker mode prescription in all patients undergoing new pacemaker implantation from 1992 to 1994. Comparison with retrospectively obtained data for patients paced from 1984 to 1991. SETTING: Tertiary referral cardiothoracic centre. PATIENTS: Group 1: 2622 patients paced at one centre and entered into the national pacing database from 1984 to 1991. Group 2: 1088 consecutive patients paced from 1992 to 1994. RESULTS: Use of atrial (AAI) and dual chamber (DDD) pacemakers increased progressively in patients of all ages from 1984 to 1994. There was an increase in the proportion of patients aged 80 years and older from 25.4% (group 1) to 40.5% (group 2). Patients of all ages in group 2 were more likely to receive DDD units for atrioventricular block (odds ratio (95% confidence interval) (CI) 9.0 (7.0 to 11.5)) and AAI or DDD units for sinus node disease (odds ratio (95% CI) 11.0 (7.7 to 15.8)) than those in group 1. Elderly patients (age > or = 80 at implant) with atrioventricular block or sinus node disease and a suitable atrial rhythm were less likely to receive DDD or AAI pacemakers than younger patients in both groups. CONCLUSIONS: Use of atrial and dual chamber pacing modes has increased substantially in patients of all ages over the last decade. Although elderly patients represent an increasing proportion of the paced population, they remain less likely to receive atrial or dual chamber pacemakers than younger patients.
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- Andersen H. R., Thuesen L., Bagger J. P., Vesterlund T., Thomsen P. E. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet. 1994 Dec 3;344(8936):1523–1528. doi: 10.1016/s0140-6736(94)90347-6. [DOI] [PubMed] [Google Scholar]
- Ausubel K., Steingart R. M., Shimshi M., Klementowicz P., Furman S. Maintenance of exercise stroke volume during ventricular versus atrial synchronous pacing: role of contractility. Circulation. 1985 Nov;72(5):1037–1043. doi: 10.1161/01.cir.72.5.1037. [DOI] [PubMed] [Google Scholar]
- Bernstein A. D., Camm A. J., Fletcher R. D., Gold R. D., Rickards A. F., Smyth N. P., Spielman S. R., Sutton R. The NASPE/BPEG generic pacemaker code for antibradyarrhythmia and adaptive-rate pacing and antitachyarrhythmia devices. Pacing Clin Electrophysiol. 1987 Jul;10(4 Pt 1):794–799. doi: 10.1111/j.1540-8159.1987.tb06035.x. [DOI] [PubMed] [Google Scholar]
- Bernstein A. D., Parsonnet V. Survey of cardiac pacing in the United States in 1989. Am J Cardiol. 1992 Feb 1;69(4):331–338. doi: 10.1016/0002-9149(92)90229-r. [DOI] [PubMed] [Google Scholar]
- Channon K. M., Cripps T. R., Ormerod O. Recommendations for pacing. BMJ. 1992 Dec 5;305(6866):1431–1432. doi: 10.1136/bmj.305.6866.1431-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Channon K. M., Hargreaves M. R., Cripps T. R., Gardner M., Ormerod O. J. DDD vs. VVI pacing in patients aged over 75 years with complete heart block: a double-blind crossover comparison. Q J Med. 1994 Apr;87(4):245–251. [PubMed] [Google Scholar]
- Cohen S. I., Frank H. A. Preservation of active atrial transport; an important clinical consideration in cardiac pacing. Chest. 1982 Jan;81(1):51–54. doi: 10.1378/chest.81.1.51. [DOI] [PubMed] [Google Scholar]
- Heldman D., Mulvihill D., Nguyen H., Messenger J. C., Rylaarsdam A., Evans K., Castellanet M. J. True incidence of pacemaker syndrome. Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1742–1750. doi: 10.1111/j.1540-8159.1990.tb06883.x. [DOI] [PubMed] [Google Scholar]
- Hesselson A. B., Parsonnet V., Bernstein A. D., Bonavita G. J. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol. 1992 Jun;19(7):1542–1549. doi: 10.1016/0735-1097(92)90616-u. [DOI] [PubMed] [Google Scholar]
- Kruse I., Arnman K., Conradson T. B., Rydén L. A comparison of the acute and long-term hemodynamic effects of ventricular inhibited and atrial synchronous ventricular inhibited pacing. Circulation. 1982 May;65(5):846–855. doi: 10.1161/01.cir.65.5.846. [DOI] [PubMed] [Google Scholar]
- McComb J. M., Bexton R. S. Permanent pacemakers and the elderly: concerns, costs and benefits. Br Heart J. 1995 Jul;74(1):9–10. doi: 10.1136/hrt.74.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Northridge D., Hall R. J. Cardiological services for the elderly. J R Coll Physicians Lond. 1995 Jan-Feb;29(1):9–10. [PMC free article] [PubMed] [Google Scholar]
- Payne G. E., Skehan J. D. Issues in cardiac pacing: can agism be justified? Br Heart J. 1994 Aug;72(2):102–103. doi: 10.1136/hrt.72.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Perrins E. J., Morley C. A., Chan S. L., Sutton R. Randomised controlled trial of physiological and ventricular pacing. Br Heart J. 1983 Aug;50(2):112–117. doi: 10.1136/hrt.50.2.112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Petch M. C. Who needs dual chamber pacing? BMJ. 1993 Jul 24;307(6898):215–216. doi: 10.1136/bmj.307.6898.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pycock C. J., King A., Marshall A. J. Management of heart disease in the elderly in the Plymouth Health District. J R Coll Physicians Lond. 1995 Jan-Feb;29(1):15–19. [PMC free article] [PubMed] [Google Scholar]
- Ray S. G., Griffith M. J., Jamieson S., Bexton R. S., Gold R. G. Impact of the recommendations of the British Pacing and Electrophysiology Group on pacemaker prescription and on the immediate costs of pacing in the Northern Region. Br Heart J. 1992 Nov;68(5):531–534. doi: 10.1136/hrt.68.11.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Recommendations for pacemaker prescription for symptomatic bradycardia. Report of a working party of the British Pacing and Electrophysiology Group. Br Heart J. 1991 Aug;66(2):185–191. [PMC free article] [PubMed] [Google Scholar]
- Rosenqvist M., Brandt J., Schüller H. Atrial versus ventricular pacing in sinus node disease: a treatment comparison study. Am Heart J. 1986 Feb;111(2):292–297. doi: 10.1016/0002-8703(86)90142-0. [DOI] [PubMed] [Google Scholar]
- Rosenqvist M., Brandt J., Schüller H. Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J. 1988 Jul;116(1 Pt 1):16–22. doi: 10.1016/0002-8703(88)90244-x. [DOI] [PubMed] [Google Scholar]
- Sulke N., Dritsas A., Bostock J., Wells A., Morris R., Sowton E. "Subclinical" pacemaker syndrome: a randomised study of symptom free patients with ventricular demand (VVI) pacemakers upgraded to dual chamber devices. Br Heart J. 1992 Jan;67(1):57–64. doi: 10.1136/hrt.67.1.57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutton R., Kenny R. A. The natural history of sick sinus syndrome. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1110–1114. doi: 10.1111/j.1540-8159.1986.tb06678.x. [DOI] [PubMed] [Google Scholar]
- de Belder M. A., Linker N. J., Jones S., Camm A. J., Ward D. E. Cost implications of the British Pacing and Electrophysiology Group's recommendations for pacing. BMJ. 1992 Oct 10;305(6858):861–865. doi: 10.1136/bmj.305.6858.861. [DOI] [PMC free article] [PubMed] [Google Scholar]