Background: Cardiac pacing has evolved rapidly since its inception in the late 1950's. Most recently, we have witnessed a number of new indications for pacing that are based not on the need to treat bradycardia, the most common indication, but on an attempt to improve hemodynamics. This maybe intermittent or permanent, maybe due to complete heart block, 2nd degree atrioventricular block or sinus node dysfunction and in some instances in asymptomatic patients because of the risk of developing untoward symptoms. Symptoms must be directly attributable to the bradycardia and may include syncope, dizziness, exercise tolerance, and heart failure. Currently sinus node dysfunction is the most frequent indication for pacing followed by AV node dysfunction.
Research Question: What are the indications, patient characteristics and early complications of permanent pacemaker insertion at the Philippine Heart Center (PHC)
General Study Design: Retrospective, descriptive
Participants: All adult patients who had permanent pacemaker insertion for the first timeat the PHC from January 2003 to October 2004.
Analysis: Descriptive statistics were used to summarize data into means, frequencies and proportions/percentages.
Results: Ninety two adult patients who had PPI insertion were included in the study. The mean age was years of which~ere male and.Li--were female. Hypertension was the most commonly identified nsk factor (66%), syncope was the most frequent clinical presentation (44%) and sick sinus syndrome was the most common indication for PPI insertion (47.8%) followed by 3rd degree AV block. Majority of the patients, both in SSS and complete heart block population had VVI as the pacing mode. Major complications occurred in two (2 %) patients. One patient inserted with DDD pacemaker developed hypotension after the operation and had upper GI bleeding with deranged bleeding parameters and succumbed due to DIC. One patient had lead dislodgment necessitating lead replacement after three months. Minor complications occurred in one patient as hematoma 24 hours after the surgery at the post operative site requiring evacuation.
Conclusion: In this report, we noted that majority of our patients who undergo permanent pacemaker insertion belong to the elderly populations with symptomatic bradycardia and majority of these cases are caused by sick sinus syndrome. In our institution permanent pacemaker insertion carries a low risk for complications and a low mortality rate.