Follow-up Management of the Paced Patient

Pacemaker dependency after implantation of electrophysiological devices

“…In general, pacemaker-dependent patients have inadequate or even absent intrinsic rhythm and therefore can suffer significant symptoms or cardiac arrest after cessation of pacing. 9,10 The issue of pacemaker dependency is complex and actually there is a great diversity of definitions in the available literature. The need for a widely acceptable, clinically applicable, and practical definition has been recently underlined.…”

“…9,10 Some physicians consider the patient to be pacemaker-dependent if the ventricular rhythm is totally paced whenever seen in the pacemaker clinic or if the interrogation of the device shows that most of the time there is ventricular pacing according to the stored percentage of paced ventricular events. 9,10 However, this practice does not take into account several potential settings such as dual-chamber pacing with short atrioventricular (AV) delay, ventricular pacing with high base rate, no programming of features that promote intrinsic ventricular rhythm, biventricular pacing where the AV delay is usually short, or no programming of specific features that promote biventricular pacing in CRT systems (algorithms that promote continuous tracking and manage the premature ventricular beats). 2,3 The classical definition of pacemaker dependency includes the occurrence of asystole after cessation of ventricular pacing, namely the absence of an underlying escape rhythm.…”

“…10,13,14,17 In addition, it has been proposed that patients who receive a PPM for syncope due to intermittent asystole should be treated as pacemaker-dependent, even if they have seemingly a reliable underlying heart rhythm during the regular follow-up, given that in the case of pacing system failure, they would not be protected from recurrent spells. 9,10 Pacemaker dependency testing is routinely performed during the regular follow-up of patients with EPDs. In most of the reported tests, a decrease in the base paced rate to 30 -40 bpm is performed and then a close observation for an underlying intrinsic ventricular rhythm as well as recording of patients' symptoms.…”

Prevalence and predictors of pacemaker dependency: Data from a cardiac centre registry in Iraq

“…In the present study pacemaker dependency was identifi ed in 17% of the enrolled patients, a wide range of incidence (2.1-50%) of pacemaker dependency was mentioned in the available literatures. 8,9 This difference may be attributable to the protocol that is used to defi ne pacemaker dependency, Lelakowski et al 10 used cessation of pacing for 5 second with inclusion of patient symptoms and the rate in his study was 2.1%, Nagatomo et al 7 lowered the pacing rate to 30 bpm but didn't include the symptoms in the test for dependency, the rate of PMD in his study was 7.2%. Glikson et al 11 used 50 bpm as a cutoff point to defi ne PMD, so the incidence of PMD was 50%.…”