title: Clinically guided pacemaker choice and setting: pacemaker expert programming study.
abstract: OBJECTIVE
  The aim of this multicentre, observational, transversal study was to evaluate pacemaker (PM) choice and setting in a large number of patients, in order to understand their relationship with the patients' clinical characteristics.
  
  
  RESULTS
  The study enrolled a total of 1858 patients (71 ± 14 years, 54% male), consecutively evaluated during scheduled PM follow-up visits in 7 Italian cardiac arrhythmia centres. To evaluate the appropriateness of PM choice in relation to the patients' clinical characteristics, we analysed their rhythm disorders at the time of device implantation and the characteristics of the devices implanted. To evaluate the appropriateness of device setting, current rhythm disorders and device setting at the time of enrolment were analysed. In the overall study population, 64.3% of the patients received a PM with all of the features required for their rhythm disorder [80.8% in persistent atrioventricular (AV) block, 76.5% in atrial fibrillation needing pacing, 71.0% in sinus node disease, 58.7% in non-persistent atrioventricular block (AVB), 52.7% in neuro-mediated syncope]. The most frequent cause of inappropriate PM choice was the lack of an algorithm to promote intrinsic AV conduction in non-persistent AVB patients (38.1%). In 76.2% of the patients with an appropriate PM (n = 1301), the PM was optimally set for their rhythm disorder.
  
  
  CONCLUSIONS
  In the present 'real-world' registry, a large number of patients (35.7%) did not receive an optimal PM for their rhythm disorders. Moreover, one-fourth of appropriate PMs were not programmed according to the patients' clinical characteristics.
authors.affiliation: Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.affiliation: Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Palmisano
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ammendola
authors.affiliation: Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dell'era
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aquilani
authors.affiliation: Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Aspromonte
authors.affiliation: Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.|Department of Cardiology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Accogli
authors.affiliation: Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Del Giorno
authors.affiliation: Division of Cardiology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Renato Pietro
authors.initials: RP
authors.lastname: Ricci
authors.affiliation: Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Maglia
authors.affiliation: Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D000066491:Clinical Decision-Making; D020878:Device Removal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018579:Patient Selection; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bradyarrhythmias; Device setting; Pacemaker; Permanent pacing; Rhythm disorder