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A prospective audit of pacemaker function, implant lifetime, and cause of death in the patient
S K Suvarna1, R D Start, D I Tayler
1Department of Histopathology, Northern General Hospital, Sheffield, UK. S.K.Suvarna@Sheffield.ac.uk
Insights
This audit found no pacemaker dysfunction in patients who died. The study suggests arrhythmias in cardiomyopathy are significant, and the short interval between pacemaker implantation and death warrants further investigation.
Area of Science:
- Cardiology
- Medical Device Engineering
Background:
- Pacemaker implantation is a common procedure for managing cardiac arrhythmias.
- Understanding pacemaker longevity and patient outcomes is crucial for clinical practice.
Purpose of the Study:
- To prospectively audit reasons for pacemaker implantation.
- To assess pacemaker duration of use and function post-mortem.
- To determine causes of death in pacemaker recipients.
Main Methods:
- Pacemakers were retrieved from deceased patients across three hospitals over three years.
- Causes of death were determined via necropsy or death certificates.
- Pacemaker function (battery, program, output) was analyzed under standard load.
Main Results:
- 69 patients were studied, with an average implantation duration of 46 months.
- No primary or secondary pacemaker dysfunction was detected.
- Ischemic heart disease and cardiomyopathy were significant causes of death.
Conclusions:
- Pacemaker device function was consistently within normal limits.
- Arrhythmias associated with cardiomyopathy appear impactful in this patient group.
- The short interval between pacemaker implantation and death requires further research.
Aim:
To audit prospectively the reasons for pacemaker implantation, the duration of the pacemaker use, the cause of death, and pacemaker function after removal from the patient.
Methods:
Pacemakers were removed at necropsy, or from the bodies of patients awaiting cremation, in three hospitals over a three year period. The cause of death was taken from the results of the necropsy or from the certified cause of death. Demographic data, including the time of implant and reasons for implantation, were checked. The pacemakers were analysed in terms of battery status, program, and output under a standard 470 ohm load.
Results:
69 patients were studied. Average age at death was 78 and 80 years for men and women, respectively. The average duration since pacemaker implantation was 46 months. Eleven patients had necropsies, showing that three died from ischaemic heart disease, six from cardiomyopathy, one from an aortic aneurysm, and one from disseminated neoplasia. From the necropsy results and death certificates, the distribution of causes of death in the group as a whole were ischaemic heart disease (21), cardiomyopathy (8), cerebrovascular disease (11), neoplasia (11), chest infection/chronic obstructive airways disease (8), and other causes (10). In all cases the pacemaker box function was within normal limits.
Conclusions:
Neither primary nor secondary pacemaker dysfunction was found. The study highlights the impact of arrhythmias in cardiomyopathy, and raises questions about the true role of ischaemic heart disease in these pacemaker requiring patients. The relatively short gap between pacemaker implantation and death requires further study.