Pacemaker implantation by surgeons and cardiologists: Comparing two different eras

Since cardiac surgeons have not kept up with advancements in pacing technology, there has been a tendency to limit the implantation of pacemakers by surgeons. This study compares two eras of pacing therapy including pacemaker implantation by cardiac surgeons and pacemaker set-up by a group of cardiologists in Shahid Rajaee Hospital in Tehran. In this cross-sectional study, we compared the existing data from all pacemaker implantations in the first half of 1999 (surgical era, era 1) to that of the first half of 2001 (cardiologists era, era 2). During era 1, a total 114 pacemakers (46.5% male, mean age 63.3 ±18.4) and during era 2, 299 pacemakers (63.9% male, mean age 63.9±18.2) had been implanted. Indications for implantation were nearly similar, with AV block as the most common reason in 21.9% and 19.1% of implantations in eras 1 and 2, respectively. Single chamber pacemakers comprised 86% of implantations during era 1 compared to 54% during era 2 (p<0.01). The mean duration of admission was 18 days during era 1 while it was 10 days during era 2. Pacemaker malfunctions were detected following 7.9% of implantations in era 1 compared to 0.3% of cases in era 2 (p<0.01). Re-do procedures were performed after 2.7% of implantations during era 1 in comparison to 0.3% during era 2 (p<0.01). Pacemaker implantation was performed better by a coordinated pacemaker service run by cardiologist trained in pacemaker implantation.