Should surgeons still be implanting pacemakers?

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Technology

Background:

• Cardiac pacing has evolved significantly in terms of personnel, technology, and cost.
• Concerns exist regarding the declining role of surgeons in pacing due to non-surgeon-led implants and technological advancements.
• Reimbursement changes necessitate resource consolidation in bradycardia pacing.

Purpose of the Study:

• To analyze the current role of cardiothoracic surgeons in pacemaker therapy delivery.
• To evaluate the outcomes of cardiothoracic surgical involvement in pacemaker implantation.

Main Methods:

• A retrospective study examining two eras of pacemaker implantation (1986-1992) at an institution with cardiothoracic surgeon-led procedures.
• Analysis of complication and infection rates across 1,562 procedures.
• Comparison of implant types and follow-up protocols between Era 1 (pre-Pacemaker Service) and Era 2 (post-Pacemaker Service).

Main Results:

• Overall complication rate was 5.2% and infection rate was 0.51% across 1,562 procedures.
• Era 1 (1986-1989) primarily used single-chamber implants with incomplete follow-up.
• Era 2 (1989-1992) saw increased dual-chamber implant use (53.9%) with a coordinated medical-surgical approach and comprehensive follow-up, maintaining low complication rates.

Conclusions:

• Cardiothoracic surgeons can maintain low complication and infection rates in pacemaker implantation.
• A coordinated medical-surgical approach, including comprehensive follow-up, is effective in modern pacemaker therapy.
• Surgical involvement remains valuable in cardiac pacing, particularly with evolving technology and patient care models.