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Abstract Session 5: Cardiac Pacing Advances and Modern Practice

Monday, April 3, 2006, 2:00–3:30pm

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APPLICATION OF NATIONAL GUIDANCE ON PACING MODE

Dr. Chris Plummer 1 , Janet McComb 1 , Richard Charles 2 , Morag Cunningham 3 , David Cunningham 3
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Department of Cardiology, Cardiothoracic Centre, Liverpool, United Kingdom of Great Britain and Northern Ireland
,
National Pacemaker and ICD Database, Strathclyde, United Kingdom of Great Britain and Northern Ireland
Introduction: UK national clinical guidance on mode of pacing in sick sinus syndrome (SSS) and/or atrioventricular block (AVB) was published in February 2005 and states that “Dual-chamber pacing is recommended for the management of symptomatic bradycardia due to SSS, AVB, or a combination of SSS and AVB, except in the management of SSS in patients in whom, after full evaluation, there is no evidence of impaired atrioventricular conduction; in this situation, single-chamber atrial pacing is appropriate." We have audited UK practice against these standards, as recommended in the guidance. Methods: We interrogated the National Pacemaker and ICD database for pacemaker indications and pacing modes and reviewed published data on the incidence and prevalence of AVB in SSS. Results: In the UK during 2004-5, 58.8% of first pacemaker implants were dual chamber (D), 39.1% single chamber ventricular (V), and 1.3% single chamber atrial devices (A). The indications for pacing were 46.4% AVB, 28.5% SSS, and 23.8% atrial fibrillation (AF) with bradycardia. The number of V implants (39.1%) exceeds the number for AF by 15.3%, suggesting that these patients without AF are receiving V pacing inappropriately. Also, evidence from published literature suggests that 49% of those paced for SSS, have normal AV conduction suggesting that 12.7% ([28.5 × 49%]– 1.3%) could be paced in A mode (Fig 1). Conclusions: Full implementation of UK national guidance would result in a 15.3% reduction in V pacing and a 12.7% increase in A pacing. There would be a small increase in pacemaker upgrades due to the development of AV block (approximately 1.5% pa) but overall the changes would be broadly cost neutral with the numbers of single and dual chamber devices implanted remaining static despite the more widespread use of an optimal pacing mode.
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Document Type: Research Article

Publication date: April 1, 2006

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