Critical Analysis of Pulse Generator Replacement

Abstract

A review of 633 pacemaker pulse generator replacements performed over 5.7 years revealed that the average life of pacemakers replaced electively (29.1%) was 24.9 months, while that of failed pacemakers (54.7%) averaged 21.6 months. Asynchronous pacers (169) lasted a mean 25.0 months and 301 demand pacers, 21.4 months. The average longevity of all pacemakers removed for all reasons was 20.7 months. Examining the evolution from (1) no clinic to (2) a routine pacemaker clinic to (3) a Pacemaker Evaluation Center with telephone analysis and peripheral clinic network, it is demonstrated that although the use of a clinic alone improved mean pacer longevity from 18.4 to 22.9 months, the evaluation center with telephone surveillance produced the greatest longevity of pacemaker units (25 units removed for failure, mean life 26.4 months). The number of electrode-related problems decreased from 15.2% to 10.7%, and the average life of pacemakers removed for these reasons increased from 5.4 to 16.7 months. Infection and erosion were also encountered less frequently (11.6% to 5.0%), and implant duration was increased (7.1 to 16.1 months). Emergency admissions decreased from 55% in 1968 to 10% in 1973, and similarly, return of symptoms dropped from 66% to 27%. We have found that a pacemaker clinic that uses a team approach reduces patient risk, alters the pattern of morbidity, and prolongs pacer longevity. Telephone surveillance may offer the greatest potential for longer pacemaker life but has numerous practical implications regarding increasing cost, time, and personnel.