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Survey of cardiac pacing in Canada (1993)
B S Goldman1, S Nishimura, C Lau
1Pacemaker Clinic, Sunnybrook Health Science Centre, Toronto, Ontario.
Insights
Cardiac pacing in Canada showed slow growth in new implants in 1993, with sinus node and atrioventricular node disorders being primary indications. Use of single chamber rate-adaptive devices increased.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac pacing status in Canada in 1993 was assessed via physician surveys and manufacturer data.
- A 25% physician response rate (33 of 128) was achieved.
Purpose of the Study:
- To determine the status of cardiac pacing in Canada in 1993.
- To analyze trends in pacemaker implants, indications, and technology.
Main Methods:
- Data collected from 33 physicians and four manufacturers/distributors.
- Analysis of new pacemaker implants per million population, indications, device types, and lead technologies.
- Assessment of peri-operative reprogramming and patient hospitalization for new implants versus replacements.
Main Results:
- New pacemaker implants were 268 per million population, similar to 1989 levels.
- Sinus node disorders (38.2%) and atrioventricular node dysfunction (33.1%) were the main indications.
- Single chamber devices dominated (76%), with a notable increase in rate-adaptive units (25%).
Conclusions:
- Cardiac pacing in Canada exhibited limited growth compared to previous years and other countries.
- Conservative indications and a steady use of dual-chamber devices were observed.
- Concerns were raised about budget constraints potentially limiting pacemaker therapy growth.
Introduction:
The status of cardiac pacing in Canada in 1993 was determined from data provided by 33 of 128 physicians surveyed (25% response) and four major manufacturer/distributors.
Demographics:
There were 268 new implants per million population, similar to the 1989 data, 279 per million.
Indications:
Sinus node disorders accounted for 38.2% of implants, atrial fibrillation with slow ventricular response for 18.1% and atrioventricular node dysfunction for 33.1% of patients. Implants for tachyarrhythmias accounted for only 3.5%.
Technology:
Single chamber units were implanted in 76% of patients and dual chamber in 23%, with rate modulation used in 35% of primary implants. There was an increase in the use of single chamber rate adaptive units from 1989 (from 15.9% to 25%). The per venous sheath introducer technique was used in 55% of lead insertions. Bipolar leads were used in 78% of atrial and 63% of ventricular leads; passive steroid leads were used in 50% of atrial and 55% of ventricular lead implants; 40% of atrial leads and 7.5% of ventricular leads had active fixation.
Follow-Up:
Most pulse generators were reprogrammed peri-operatively or within three months (97.4%). Most patients with new implants (92%) required hospital admission for 2.5 days, while 75% of replacements were out-patient procedures.
Conclusions:
Comparison with previous surveys and other countries revealed little growth in pacemaker sales or new implant rates per million population; conservative indications and relatively constant use of dual chamber devices; and an increase in single chamber rate responsive units. The authors express concern regarding budget constraints and resource availability as factors limiting growth in pacemaker therapy.