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Criteria for pacemaker explant in patients without a precise indication for pacemaker implantation
Martino Martinelli1, Roberto Costa, Silvana Nishioka
1Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil. martino@incor.usp.br
Pacing and Clinical Electrophysiology : PACE
|May 7, 2002
Summary
Pacemaker explantation is feasible in selected patients without clear indications, offering significant social, economic, and psychological benefits. This study evaluated a protocol for safely removing pacemakers in such individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Management
Background:
- Unnecessary pacemaker implantation leads to social, psychological, and financial burdens.
- Establishing criteria for pacemaker explantation is needed but not yet described.
Purpose of the Study:
- To present a study protocol for pacemaker explantation in patients lacking clear implantation indications.
- To assess the safety and efficacy of pacemaker explantation in a selected cohort.
Main Methods:
- Prospective follow-up of 70 pacemaker users without clear indications.
- Inclusion of clinical, neurological, echocardiogram, exercise, and tilt table testing.
- Reprogramming devices to lowest settings, Holter monitoring, and electrophysiological studies before explantation.
Main Results:
- Pacemaker explantation was successfully performed in 35 out of 70 patients.
- Three patients were excluded due to positive diagnostic tests.
- Mean follow-up of 30.3 months post-explantation showed patients remained asymptomatic, barring one non-cardiac death.
Conclusions:
- A critical analysis of pacemaker use without clear indications is warranted.
- Pacemaker explantation can be safely achieved in a significant proportion of these patients.
- Successful explantation yields considerable social, economic, and psychological advantages.