Permanent Pacemaker Implantation: an Analysis of 147 Cases.

Abstract

SUMMARY:
At. Mayo Hospital Lahore 147 cases had permanent pacemaker implantation from 1978-85 53.1% were na1es and 46.9% females. Most of the patients were above the age of’ 50 years. Amongst these, 76% patients presented with acquired C.H.B., 8% with S.S.S., 5% with intermittent H.B., 4% with congenital C.H.B., 2.7% with post M. I. defects, 2.7% with symptomatic 2nd degree A. V. Block, and 1.3% with A.F’. with vent. rateless than 4O hadpermanentpacemakersjmpltd Transvenous, endocardial VVJ type of pacemakers were used in all cases. In 32.6% of cases tined lead was implanted, Average pacing threshold was between 0.5M.7 V. and 0.6-0.8 mA. 90.5% of patients received the pacemakers as their first implant and in only 9.5% of patients second implant was done. Prophylactic Antibiotics were used routinely. Percentage of various early and late complications were as follows: Hematoma formation 15.6%, lead displacernen 6%, Infection 5,9%, Diaphragmatjc stimuhtjon 2.7%, rectoraj muxcie stimulation 2.04%, lead fractjre 2.04%, pacemaker migration 2.04%, erosion of skin by lead 1.3%, early increase in threshold, early failure to sense, pacemaker generated arrhythmjas.and pulse generator corn poñent failure all happened with 0.6%. Only 64% patients purchased pacemakers by themselves. 24% were provided by raising funds and 12% got from government sources.

MATERIAL AND RESULTS:

The Cardiac pacemaker is the most successful electronic device implanted in the body. It has been in use worldwide over the last quarter century as one of the mainstays of modern cardiac therapy.FigureII shows that most of the patients were above the age of 50 years without any significant dominance of either sex. Although ‘6’ patients above the age of 80 years were males.

METHODOLOGY:

Patients selection as a candidate for permanent pacem aker has been divided into two main groups. As shown in Table -I.Thorough investigations like Holter monitoring and His bundle electrophysiological studies were done to further establish the indicat ion for permanent pacing. These were patients mostly with Sick sinus syndrome or having varous facicular blocks.