Surgical aspects of permanent cardiac pacemakers

This study discusses the surgical aspects of permanent cardiac pacemakers with reference to a ten-year review involving 628 procedures. The most suitable route for electrode placement was found to be subclavian vein puncture, access being achieved in 97% of cases. This method was however, associated with a small incidence of pneumothorax (1.4%) and haemothorax (0.9%). The commonest late complication is infection in spite of sterile technique and antibiotic prophylaxis. Experience with infected pacemakers suggest that the best line of management is complete removal of the system followed by delayed replacement once the infection has been eradicated. Pacemaker technology is constantly improving, providing both patient and physician with increasingly elaborate tools. In order to reap the benefit of these pacemakers, the data from this review demonstrates the need for meticulous technique in their insertion and an ability to deal with any complication promptly and adequately.