Abstract
This study was done at a UK tertiary referral Cardiothoracic center to evaluate the
influence of the British Pacing and Electrophysiology Group (BPEG) guidelines for
pacemaker prescription on pacing practice in patients aged 80 and over. Prospective
evaluation was made of indications for pacing and pacing mode used in these patients
undergoing their first endocardial pacemaker implant at our center from April 1992
to September 1993. Indications for pacing and pacing mode used in patients aged 80
and over paced at our center from 1984 to 1991 and entered into the United Kingdom
(UK) national pacing database were retrospectively analyzed. Data were compared for
both groups with the BPEG recommendations for pacemaker prescription. The patients
were divided into two groups: group 1 consisted of 369 patients aged 80 and above
of 926 consecutive patients undergoing their first endocardial permanent pacemaker
implant from 1992 to 1993; group 2 included 593 patients aged 80 and above out of
a total of 2622 patients paced at our center and entered into the national pacing
database from 1984 to 1991.
An increase was found in the proportion of paced patients aged 80 or over from 23%
(1984–1991) to 40% (1992–1993). Indications for pacing were broadly similar in the
two groups. Use of optimal (DDD) pacing mode for atrioventricular block increased
significantly after 1991, from 15.4% (group 2) to 52.8% (group 1), p < 0.001. Use of physiological (AAI or DDD) pacing in sinus node disease (SND) also
increased from 21.9% (group 2) to 45.9% (group 1). There was no difference between
the two groups in the use of rate-responsive ventricular pacing for chronic atrial
fibrillation with atrioventricular block. An increasing proportion of patients undergoing
permanent pacing are aged 80 and above. The development of national (BPEG) guidelines
for pacemaker prescription has led to a significant increase in physiological pacing
in this elderly group of patients.
