The 1981 United States survey of cardiac pacing practices

A survey of physicians implanting pacemakers was conducted to obtain a profile of permanent cardiac pacing practices in the United States during 1981. Questionnaires were mailed to 5,832 implanters with 765 responses (13%) received and 680 analyzed. It was estimated that there were approximately 5,600 physicians, 66% surgeons and 34% nonsurgeons, implanting pacemakers at 3,670 centers. About 118,000 new primary implants were performed, or 518 per million population. Only 17% of implantation procedures in 1981 were replacements compared with 31% in 1978. Roughly half the respondents worked in teams, most implanting from 46 to 55 pacemakers annually. The chief indications for permanent pacing were sick sinus syndrome (48%) and impairment of conduction in the atrioventricular node and His-Purkinje system (42%). Ninety-five percent of pacing leads were implanted transvenously. Seventy percent of the respondents had had experience with atrial and dual-chamber pacemakers, used largely to increase cardiac output. The use of ventricular demand (VVI) pacing decreased accordingly from 91% in 1975 to 84% in 1981. Although approximately 90% of primary pacemakers were programmable to some degree, almost half were not reprogrammed within the first 3 months after implantation and 30% were never reprogrammed. Most patients (85%) were followed up by transtelephonic electrocardiographic monitoring, 68% in conjunction with private office visits. The respondents estimated that dual-chamber pacing, accounting for 10% of implants in 1981, would increase to 37% by 1985. Early electrode malfunctions were less frequent when implantation was performed by high volume and solo implanters, and in public and community hospitals. It is concluded that periodic surveys of this type disclose important trends in the practice of cardiac pacing.