Obligatory external quality control: a mandatory demand in device therapy

Abstract

Cardiac pacing has developed into a technically reliable and efficient treatment for patients with bradycardic heart diseases. Randomized controlled trials have been done documenting the efficacy of this treatment with respect to improvement in quality of life and reduction in morbidity as well as to which pacing mode to select. However, in each centre performing pacemaker implantations, a continuous work still should be done aiming at improvement of treatment quality and at reducing side effects and complications. For this purpose, the regular feedback from obligatory well-organized quality control programmes is invaluable. Nowak et al. 1 present a study of the effect of patient gender on pacemaker implantation based upon analysis of pre- and peri-operative data from a cohort of 17 800 consecutive patients undergoing primary pacemaker implantation and reported as part of an obligatory external quality control programme. Some very interesting findings regarding pacing mode selection and complications of pacemaker treatment appeared in this analysis. A surprisingly high percentage of patients received a single-lead ventricular (VVI) pacemaker system instead of a physiological pacemaker system that preserves synchrony between the atria and the ventricles. More women than men were treated with VVI pacing. Restricting the analysis to patients treated in small centres performing less than 20 pacemaker implantations per year, the gender differences were extreme, with 60% of women receiving VVI devices vs. 45% of men, but still in the remaining larger centres as many as 39% of women and 33% of men were treated with VVI devices. In the elderly population, significantly more women than men received VVI pacemaker systems, both in … *Corresponding author. Tel: +45 89 49 55 66, Fax: +45 89 49 60 02, Email: jenniels{at}rm.dk