title: Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation.
abstract: OBJECTIVE
  The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM.
  
  
  METHODS
  Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation.
  
  
  RESULTS
  Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality.
  
  
  CONCLUSIONS
  Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jang
authors.affiliation: Virginia Mason Medical Center, WA, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Rho
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Tae-Seok
authors.initials: TS
authors.lastname: Kim
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Gimhae Jungang Hospital, Busan, Korea.
authors.forename: Woo-Seung
authors.initials: WS
authors.lastname: Shin
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Yong-Seog
authors.initials: YS
authors.lastname: Oh
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Man Young
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Takeda Hospital, Kyoto, Japan.
authors.forename: Eiwa
authors.initials: E
authors.lastname: Zen
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Tai-Ho
authors.initials: TH
authors.lastname: Rho
keywords: Atrioventricular block; Guidelines; Pacemaker, artificial; Physicians; Sick sinus syndrome