Cardiac pacing practices in the United States in 1985

Physicians active in pacemaker implantation and follow-up were surveyed to obtain a profile of permanent cardiac pacing practices in the United States during 1985. Questionnaires were sent to 628 physicians, mainly in New Jersey; 145 responses were received and analyzed. A separate questionnaire was sent to 9 pacemaker manufacturers to solicit information concerning the volume of pacemaker sales and their opinions on a variety of subjects. The rate of permanent pacemaker implantation declined for the first time: it dropped from 518 devices per million population in 1981 to 374 in 1985. Sinus node dysfunction was the chief indication for permanent pacing in 52% of primary implantations; conduction disorders of the atrioventricular node and His-Purkinje system accounted for 41% and ventricular tachyarrhythmias for 2%. Dual-chamber pacing modes were used less frequently than was predicted in 1981, accounting for 30% of primary and 19% of replacement pacemakers. More than 43% of programmable pulse generators were never reprogrammed after implantation. Surveys such as this continue to provide useful information despite obstacles encountered in the use of questionnaires. Important differences in practice patterns and outcomes were identified between surgeons and nonsurgeons, and between frequent and infrequent implanters. These differences reinforce the suggestion that implanters should work at a volume sufficient to maintain their expertise, and that cooperation between surgeons and nonsurgeons would lead to improvements in patient selection, surgical results and optimal pacemaker programming and follow-up care. Better results could be achieved by adopting the continent-wide system of a pacemaker registry now used in Eastern Europe and Great Britain.