Permanent cardiac pacemakers: twelve-year experience with 287 patients

Our total pacemaker experience was evaluated to determine survival, complications, effectiveness of follow-up techniques, and future goals for surveillance. A retrospective review of 287 patients with 570 pulse generators revealed 164 alive and 104 dead; 3 recovered normal conduction, 14 transferred care, and 2 have been lost to follow-up. Average age at initial implantation was 67 years. Overall mean generator life has been 22 months. The one-, three-, five-, and ten-year survival is 84, 71, 60, and 39%, respectively. The 738 operations performed averaged 2.6 procedures per patient. Of the total survivors, 108 (66%) had no complications; 56 (34%) have had at least one complication, 70% during the first year of the initial implantation. Fifty episodes of premature interruption of pacing service were detected. Ninety-one patients (32% of the group) have required an operative procedure on their pacemaker system more frequently than every two years. Of the replacements, 89 (29%) were for reasons other than end of generator life; 66 (63%) of the deaths occurred before replacement of the first generator. Mortality in the first two years was 23%. Once survival exceeded two years the average annual death rate was 3.7% (expected, 3.2%). Survival in our series compares favorably with that of other groups who report by the actuarial method. These data suggest that some deaths, reduced patient productivity, and the high cost to health care providers may be due in part to inadequate follow-up after the first pacemaker implantation. If follow-up observation is done frequently during the first year after initial implantation and once minimum generator longevity has passed, the goals of pacemaker therapy may be achieved.