Abstract
General management of pacemakers and defibrillators has been well described previously (1–3). A recent review of 2760 procedures at the Columbia—Presbyterian campus of New York Presbyterian Hospital revealed that 23% of pacemaker recipients and 5% of implantable cardioverter defibrillator (ICD) recipients were octogenarians. The 80 to 90 yr age group also accounted for 22% of pacemaker generator replacements and 5% of ICD generator replacements. The incidence of pacemaker insertion in patients older than 75 was 2.6% in a recent survey of noninstitutionalized adults. The efficacy and cost-effectiveness of pacemaker insertion in older patients are widely accepted (1), but the appropriate role for ICD insertion in the elderly remains to be established. Problems with arrhythmia control devices in older patients include difficulty with venous access, device follow-up, effects of progressive deterioration of cardiac function, dementia/delerium during and after surgery, and complex issues encompassing patient motivation, quality-of-life, and cost. This chapter will discuss general management of pacemakers as well as issues specific to older patients.
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