Survey of cardiac pacing in Canada (1993).
BACKGROUND
The status of cardiac pacing in Canada in 1993 was determined from data provided by 33 of 128 physicians surveyed (25% response) and four major manufacturer/distributors.


METHODS
There were 268 new implants per million population, similar to the 1989 data, 279 per million.


METHODS
Sinus node disorders accounted for 38.2% of implants, atrial fibrillation with slow ventricular response for 18.1% and atrioventricular node dysfunction for 33.1% of patients. Implants for tachyarrhythmias accounted for only 3.5%.


METHODS
Single chamber units were implanted in 76% of patients and dual chamber in 23%, with rate modulation used in 35% of primary implants. There was an increase in the use of single chamber rate adaptive units from 1989 (from 15.9% to 25%). The per venous sheath introducer technique was used in 55% of lead insertions. Bipolar leads were used in 78% of atrial and 63% of ventricular leads; passive steroid leads were used in 50% of atrial and 55% of ventricular lead implants; 40% of atrial leads and 7.5% of ventricular leads had active fixation.


RESULTS
Most pulse generators were reprogrammed peri-operatively or within three months (97.4%). Most patients with new implants (92%) required hospital admission for 2.5 days, while 75% of replacements were out-patient procedures.


CONCLUSIONS
Comparison with previous surveys and other countries revealed little growth in pacemaker sales or new implant rates per million population; conservative indications and relatively constant use of dual chamber devices; and an increase in single chamber rate responsive units. The authors express concern regarding budget constraints and resource availability as factors limiting growth in pacemaker therapy.
Goldman
B S
BS
Pacemaker Clinic, Sunnybrook Health Science Centre, Toronto, Ontario.
Nishimura
S
S
Lau
C
C
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D004867:Equipment Design; D005060:Europe / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data* / Q000600:supply & distribution; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology