Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

Abstract

This report reviews the experience of permanent pacemaker insertion in a district general hospital (catchment population of 350 000) and makes a comparison with the national database and other hospitals in the UK. Methods-The records of all patients receiving a permanent pacemaker in the inclusive period January 1996 to December 1998 were reviewed. Data collected included number of patients paced each year, age, sex, indications, and complications. Results-In the three years reviewed 200 patients received new permanent pacemakers, a rate of 190 per million population per year, which is similar to the national implantation rate of permanent pacemakers but lower than that of most European countries (see discussion). The majority of patients paced were elderly (75% were above the age of 70 years).Atrioventricular block (including complete heart block, 45%, and Mobitz type 2 block, 12.5%) was the commonest indication for permanent pacemaker insertion, followed by sick sinus syndrome (25%) and these findings are comparable to those reported previously. However, carotid sinus syndrome was responsible for 16% of the patients paced and this was higher than that reported in the national database (6.5%). Only 1% of the pacemaker modes used was inappropriate and the complication rate was low at 3%. Conclusions-This report confirms that permanent pacemaker insertion can be eVectively and safely provided locally for the increasingly ageing population. The implantation rate both locally and nationally is still much lower than that of some countries in Europe. (Postgrad Med J 2000;76:337-339) Keywords: permanent pacemaker; atrioventricular block; sick sinus syndrome; carotid sinus syndromeIn 1987 the working group of the British Cardiac Society endorsed the view that permanent cardiac pacing can be eVectively performed in district general hospitals 1 ; by 1992 one third of hospitals in the UK provided this service.2 This is becoming more important nowadays as the number of elderly patients is increasing and it is more convenient for this service to be provided locally. In this study a three year experience of a district general hospital serving a population of 350 000 is reported.The aim of this study was to report a district general hospital experience in performing permanent pacemaker insertion and to compare it with that reported from a similar population and that of the national database. MethodsThe records of the patients who had had permanent pacemakers in the inclusive period of January 1996 to December 1998 were reviewed.The permanent pacemaker insertion was performed in the cardiac catheter laboratory by one of two teams: each comprised a consultant cardiologist, a specialist registrar, a cardiac technician, a cardiac nurse, and a radiographer.Prophylactic antibiotics (flucloxacillin 1 g or clindamycin 600 mg) were given intravenously routinely before permanent pacemaker insertion and continued orally (fluocloxacillin 500 mg four times a day or clindamycin 300 mg four times a day) for 48 hours afterwards. T...

Characteristics, indications and complications in patients undergoing permanent pacemaker implantation: a single centre study

“…18 Permanent pacemaker implantation remains the only effective treatment for symptomatic bradycardia. 9 This is in accordance with the reports published worldwide and reiterates that bradyarrhythmias requiring permanent pacemaker implantation constitute an important cause of geriatric morbidity. 8,9,19 This report also revealed male predominance (60% of the study patients were males) amongst the patients requiring permanent pacemakers.…”

“…In this report it showed that complete heart block (30.5%) was the most common indication for AV block and it was comparable to that reported in the earlier studies. 7,9,10 Harrigan RA et al, showed that temporary cardiac pacemaker is a life-saving procedure in the emergency department as it can definitely control the heart rate and provide adequate cardiac output in selected circumstances. 22 Among the 200 patients, 19.5% had temporary pacemaker implantation at the time of presentation in the emergency department prior to permanent pacemaker implantation.…”

“…: [4053][4054][4055][4056][4057] International Journal of Research in Medical Sciences | December 2018 | Vol 6 | Issue 12 Page 4054 Majority of the patients undergoing permanent pacemaker implantation belong to the geriatric age group. 9 Hence, bradyarrhythmias requiring permanent pacemaker implantation form an important cause of geriatric morbidity. The guidelines outlining the indications for permanent pacemaker implantation are available from the American Heart Association and the European Society of Cardiology.…”

“…11,12 The most common indications for a permanent pacemaker insertion are atrio-ventricular (AV) block and sick sinus syndrome with AV block responsible for 45-80% of pacemaker implantations in various studies. 9,10 Permanent pacemaker implantation is a minimally invasive procedure with a generally low complication rate mostly between 4-6.1%. 1,13,14 Complications are categorized into early and late.…”

Internal jugular vein thrombosis secondary to a permanent cardiac pacemaker: an unusual case of lateral neck swelling

“…16 Transvenous cardiac pacemakers are the preferred method of cardiac pacing, due to their relative ease of insertion and relatively low incidence of complications. 17 Previous studies have reported that 1.2 per cent of cardiac pacemaker insertions are complicated by some degree of symptomatic subclavian vein occlusion. 18 This incidence rises to between 44 18 and 79 per cent 16 when one takes into consideration subclinical thromboses evident only on radiological imaging.…”