The Annals of Thoracic Surgery, Vol 22, 74-79, Copyright © 1976 by The Society of Thoracic Surgeons
Permanent cardiac pacemakers: twelve-year experience with 287 patients
JW Rubin, HA Killam, HV Moore and RG Ellison
Our total pacemaker experience was evaluated to determine survival,
complications, effectiveness of follow-up techniques, and future goals for
surveillance. A retrospective review of 287 patients with 570 pulse
generators revealed 164 alive and 104 dead; 3 recovered normal conduction,
14 transferred care, and 2 have been lost to follow-up. Average age at
initial implantation was 67 years. Overall mean generator life has been 22
months. The one-, three-, five-, and ten- year survival is 84, 71, 60, and
39%, respectively. The 738 operations performed averaged 2.6 procedures per
patient. Of the total survivors, 108 (66%) had no complications; 56 (34%)
have had at least one complication, 70% during the first year of the
initial implantation. Fifty episodes of premature interruption of pacing
service were detected. Ninety-one patients (32% of the group) have required
an operative procedure on their pacemaker system more frequently than every
two years. Of the replacements, 89 (29%) were for reasons other than end of
generator life; 66 (63%) of the deaths occurred before replacement of the
first generator. Mortality in the first two years was 23%. Once survival
exceeded two years the average annual death rate was 3.7% (expected, 3.2%).
Survival in our series compares favorably with that of other groups who
report by the actuarial method. These data suggest that some deaths,
reduced patient productivity, and the high cost to health care providers
may be due in part to inadequate follow-up after the first pacemaker
implantation. If follow-up observation is done frequently during the first
year after initial implantation and once minimum generator longevity has
passed, the goals of pacemaker therapy may be achieved.
