title: Termination of implantable pacemaker therapy: experience in five patients.
abstract: BACKGROUND
  Established guidelines direct the initial implantation of permanent pacemakers. Elective replacement of these devices is common. However, no guidelines exist for the removal of permanent pacemakers and the termination of long-term cardiac pacing.
  
  
  OBJECTIVE
  To describe the feasibility and safety of terminating cardiac pacing in carefully selected patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Five adults with permanent pacemakers who were referred for pacemaker replacement or a complication related to cardiac pacing. All patients showed alleviation or reversal of the electric disturbance that originally led to the implantation of the device. The patients had received a pacemaker for a class I or II indication (that is, symptomatic bradycardia or asymptomatic, persistent third-degree atrioventricular block at the level of the atrioventricular node).
  
  
  METHODS
  After an appropriate natural rhythm was documented, pacemakers were removed from all patients.
  
  
  METHODS
  Time without recurrence of symptomatic bradycardia.
  
  
  RESULTS
  No patient had recurrent symptomatic bradycardia after 18 to 48 months of clinical follow-up.
  
  
  CONCLUSIONS
  The presence of a permanent pacemaker does not necessarily imply a permanent need for cardiac pacing. Discontinuation of cardiac pacing may be considered in certain patients. Establishing consensus criteria about the potential indications, methods, and timing of the termination of cardiac pacing seems appropriate.
authors.affiliation: University of Minnesota Medical School, Minneapolis, USA.
authors.forename: D
authors.initials: D
authors.lastname: Iskos
authors.forename: K G
authors.initials: KG
authors.lastname: Lurie
authors.forename: S
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: D G
authors.initials: DG
authors.lastname: Benditt
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D005260:Female; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome