48 Indication Spectrum of Permanent Pacemaker Implantation in a Community Hospital in New York City.

Abstract

ObjectiveThe objective of the project is to study the spectrum of indications for permanent pacemaker (PPM) implantation in a community hospital. The study also analyzed the type of pacemaker implanted, median age, and the indication for the procedure and whether a Holter exam diagnosed the indication for the pacemaker. In addition, we collected data to analyze how many patients had a temporary pacemaker placed before implantation of a permanent pacemaker.MethodsA retrospective study of all patients who had a permanent pacemaker placement in Coney Island Hospital in Brooklyn, New York from January 2000 to January 2004. Data were collected regarding the indication for the permanent pacemaker placement, age and sex of the patient, clinical presentation, and diagnostic utility of Holter.Results214 patients (111 males and 103 females) underwent PPM implantation at the Coney Island hospital in the period of 2002-2004. The age of patients ranged from 43 to 94 years with a median age of 78 years. The indication for PPM implantation was sick sinus syndrome for 103 patients (48%), third-degree AV block or high second-degree AV block for 99 patients (46%), and trifascicular block for 12 patients (5%). Presenting symptom was fall in 40% patients, syncope in 12%, dizziness in 10%, chest pain in 13%, and cardiac arrest in 2 patients; the remaining 23% patients presented with various other noncardiac illnesses like pneumonia, respiratory arrest, altered mental status, and diabetic ketoacidosis. Thirty-four percent of patients received a single-chamber PPM while 66% received a dual-chamber PPM. The diagnosis was established in only 4% of patients with the help of Holter exam. Fifty-four percent of patients had a temporary pacemaker wire inserted before a PPM. Acute myocardial infarction was diagnosed on 10% of patients.ConclusionsSick sinus syndrome and high-grade AV block appear to be major indications for permanent pacing in the elderly. Fall is an important symptom and warrants an electrocardiogram in the elderly. Utility of Holter monitoring in diagnosis to aid permanent pacing was low.