Changing trends in pacemaker prescription in patients aged 80 and over: A single center audit of 962 patients

Abstract

This study was done at a UK tertiary referral Cardiothoracic center to evaluate the influence of the British Pacing and Electrophysiology Group (BPEG) guidelines for pacemaker prescription on pacing practice in patients aged 80 and over. Prospective evaluation was made of indications for pacing and pacing mode used in these patients undergoing their first endocardial pacemaker implant at our center from April 1992 to September 1993. Indications for pacing and pacing mode used in patients aged 80 and over paced at our center from 1984 to 1991 and entered into the United Kingdom (UK) national pacing database were retrospectively analyzed. Data were compared for both groups with the BPEG recommendations for pacemaker prescription. The patients were divided into two groups: group 1 consisted of 369 patients aged 80 and above of 926 consecutive patients undergoing their first endocardial permanent pacemaker implant from 1992 to 1993; group 2 included 593 patients aged 80 and above out of a total of 2622 patients paced at our center and entered into the national pacing database from 1984 to 1991.

An increase was found in the proportion of paced patients aged 80 or over from 23% (1984–1991) to 40% (1992–1993). Indications for pacing were broadly similar in the two groups. Use of optimal (DDD) pacing mode for atrioventricular block increased significantly after 1991, from 15.4% (group 2) to 52.8% (group 1), p < 0.001. Use of physiological (AAI or DDD) pacing in sinus node disease (SND) also increased from 21.9% (group 2) to 45.9% (group 1). There was no difference between the two groups in the use of rate-responsive ventricular pacing for chronic atrial fibrillation with atrioventricular block. An increasing proportion of patients undergoing permanent pacing are aged 80 and above. The development of national (BPEG) guidelines for pacemaker prescription has led to a significant increase in physiological pacing in this elderly group of patients.