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Cardiac pacing in Northern Ireland 1979-1988
1Cardiac Unit, Belfast City Hospital.
Insights
Cardiac pacemaker implantation rates in Northern Ireland increased significantly but remain low globally. Despite changes in indications, syncope persists as the primary symptom, with a preference for advanced pacemaker models.
Area of Science:
- Cardiology
- Medical Device Technology
- Public Health
Background:
- Cardiac pacemaker implantation rates in Northern Ireland showed a notable increase between 1979 and 1988.
- The emergence of a second pacemaker implantation center coincided with this rise.
- Despite the increase, Northern Ireland's implantation rate remained lower than in many other countries.
Purpose of the Study:
- To analyze trends in cardiac pacemaker implantation rates and indications in Northern Ireland.
- To compare pacemaker usage patterns in Northern Ireland with international benchmarks.
- To evaluate patient referral patterns and the types of pacemakers implanted.
Main Methods:
- Retrospective analysis of pacemaker implantation data from Northern Ireland.
- Examination of changes in indications for pacing over a defined period.
- Comparison of pacemaker type distribution (ventricular, atrial, dual chamber) with global data.
Main Results:
- Implantation rates rose from 55.8 to over 180 per million population between 1979 and 1988.
- Indications shifted, with complete heart block decreasing and sinus node disease increasing.
- Syncope remained the most common symptom necessitating pacing; advanced pacemakers were frequently used, but referral rates were insufficient.
Conclusions:
- While pacemaker implantation has increased and advanced devices are utilized, patient referral rates in Northern Ireland are suboptimal.
- The pattern of pacemaker implantation, particularly the higher use of atrial and dual chamber devices, differs from global trends.
- Further investigation into referral pathways and patient selection for cardiac pacing is warranted.
Abstract:
The implantation rate of cardiac pacemakers in Northern Ireland rose from 55.8 per million population in 1979 to over 180 per million in 1988, with the emergence of a second pacemaker implantation centre. However, the implantation rate in Northern Ireland remains less than that of many other countries. Over the period complete heart block fell as an indication from 45% to 34% and sinus node disease rose from 16% to 28%. Symptoms necessitating pacing remained unchanged, syncope being the most common. Ventricular demand pacemakers constituted a lower proportion of implants than anywhere else in the world and more atrial demand and dual chamber pacemakers were implanted than in most other countries. Insufficient patients are being referred for pacing in Northern Ireland but a high proportion of those who are referred receive modern sophisticated pacemakers.