Waiting for a pacemaker: is it dangerous?

Area of Science:

• Cardiology
• Medical Devices
• Public Health

Background:

• Acute patients requiring permanent pacemakers (PPMs) face potential risks during waiting periods.
• Understanding waiting period-related adverse events is crucial for improving patient outcomes.

Purpose of the Study:

• To determine the morbidity, mortality, and adverse events associated with waiting for acute permanent pacemaker (PPM) implantation.
• To assess the impact of implantation capacity on waiting times and patient safety.

Main Methods:

• Retrospective chart review of 487 PPM implantations in Region Zealand, Denmark (2009).
• Analysis of adverse events, including infections, arrhythmias, cardiac arrest, and mortality, during the waiting period.
• Exclusion of patients discharged or referred from outpatient departments during the wait.

Main Results:

• 259 patients (53.2%) required acute PPM implantation, with a mean waiting time of 5.1 days.
• Capacity issues accounted for 4.5 days of the average wait.
• 32.0% of patients experienced at least one adverse event, including infection (11.2%), ventricular tachycardia (5.0%), cardiac arrest (3.1%), and mortality (1.2%).
• Isoprenaline use and malignant arrhythmias/cardiac arrest showed statistical significance (P < 0.05).

Conclusions:

• Waiting periods for acute PPM implantation are associated with significant risks.
• Capacity limitations contribute to prolonged waiting times and increased adverse events.
• A 24-hour pacemaker implantation service is recommended to ensure timely and safe PPM delivery.