Criteria for pacemaker explant in patients without a precise indication for pacemaker implantation.
Unnecessary pacemaker implantation may cause significant social and psychological consequences, the inconvenience of periodic office visits, and the expense of pulse generator replacement. Establishing adequate criteria for explantingpacemakers is crucial and has notyet been described. This study presents the results of a study protocol for explanting the pacemaker in patients without a clear indication for pacemaker implantation. Seventy pacemaker users without a clear reason for the implantation were included in the study conducted from August 1986 to November 1998 and were prospectively followed. The investigation consisted of clinical and neurological evaluations, echocardiogram, exercise testing, and tilt table testing. When these tests were negative, the pulse generator energy and stimulation rates were reprogrammed to the lowest values. Periodic Holter monitoring was conducted during follow-up. When asymptomatic for 1 year, patients underwent an electrophysiological evaluation of sinus and atrioventricular junction function and ventricular vulnerability. When the electrophysiological study was negative, pacemaker explantation was performed. Of the 70 patients, 35 had their pacemaker explanted; 3 were excluded due to a positive tilt table test and electrophysiological study, and 3 are waitingfor pacemaker explantation. Mean follow-up after pacemaker explantation was 30.3 months, and all patients remained asymptomatic, exceptfor one patient who died of a noncardiac cause. Critical analysis of pacemaker users without a well-established indication is justified because it may allowpacemaker explant in a significant proportion of these patients, and it may bring considerable social, economic, and psychological benefits.
Martinelli
Martino
M
Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil. martino@incor.usp.br
Costa
Roberto
R
Nishioka
Silvana
S
Pedrosa
Anísio
A
Siqueira
Sérgio
S
Crevelari
Elizabeth
E
Scanavacca
Maurício
M
d'Avila
André
A
Sosa
Eduardo
E
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000628:therapy; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000628:therapy; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D018579:Patient Selection; D018667:Tilt-Table Test; D019564:Unnecessary Procedures