Comparative prospective study between pacemaker implantation in the electrophysiology laboratory and at the operating room

Introduction and objectives. Permanent pacemaker implantation is done by di fferent physicians with either a surgical or clinical training. Our objecti ve was to evaluate if there were significant differences in the implantatio n parameters and in the complication rate among implantations performed by cardiologists in the electrophysiologic laboratory and cardiological surgeo ns in the operating room. Material and methods. We prospectively collected those patients' data who r eceived a first pacemaker implantation by cardiovascular surgeons and elect rophysiologists during the year 1998. Data collected included demographic i nformation, indication for pacing, surgical time, complications during proc edure, stimulation and sensing thresholds as well as type of pacing. Results. We first-implanted 216 pacemakers in a one year period, 101 by car diovascular surgeons and 115 by electrophysiologists. 56% were male patient s. Average age in the surgery group was 74.2 +/- 9 years and 72.09 +/- 12 i n the electrophysiology group (p = NS). Main diagnoses were as follows: com plete heart block in 32.9% patients, complete heart block 2.degrees 16.4%, sinus node dysfunction 12.2%, AV node ablation 12.2% and others. The compli cations rate for surgery group was 4% and 1.7% for electrophysiologists (p = NS). Electrophysiologists placed more bicameral devices. No clinically si gnificant differences were found among other implant parameters. Conclusions. Pacemaker implant by cardiologists in an electrophysiologists laboratory is a safe procedure that does not have more complications when c ompared to the same procedure done in the operating room by surgeons. This allows hospital resource optimization and reduction of hospital stay length .