TRENDS IN PACEMAKER MODE PRESCRIPTION 1984-1994 - A SINGLE-CENTER STUDY OF 3710 PATIENTS

Objective-To evaluate trends in pacemaker mode prescription from 1984 to 1994 with particular reference to the changes in pacemaker mode pre scription for patients aged 80 years and older at implant. Design-Pros pective evaluation of indications for pacing and pacemaker mode prescr iption in all patients undergoing new pacemaker implantation from 1992 to 1994. Comparison with retrospectively obtained data for patients p aced from 1984 to 1991. Setting-Tertiary referral cardiothoracic centr e. Patients-Group 1: 2622 patients paced at one centre and entered int o the national pacing database from 1984 to 1991. Group 2: 1088 consec utive patients paced from 1992 to 1994. Results-Use of atrial (AAI) an d dual chamber (DDD) pacemakers increased progressively in patients of all ages from 1984 to 1994. There was an increase in the proportion o f patients aged 80 years and older from 25.4% (group 1) to 40.5% (grou p 2). Patients of all ages in group 2 were more likely to receive DDD units for atrioventricular block (odds ratio (95% confidence interval) (CI) 9.0 (7.0 to 11.5)) and AAI or DDD units for sinus node disease ( odds ratio (95% CI) 11.0 (7.7 to 15.8)) than those in group 1. Elderly patients (age greater than or equal to 80 at implant) with atrioventr icular block or sinus node disease and a suitable atrial rhythm were l ess likely to receive DDD or AAI pacemakers than younger patients in b oth groups. Conclusions-Use of atrial and dual chamber pacing modes ha s increased substantially in patients of all ages over the last decade . Although elderly patients represent an increasing proportion of the paced population, they remain less Likely to receive atrial or dual ch amber pacemakers than younger patients.