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Article contents
Pacing in older people
Published online by Cambridge University Press: 23 March 2011
Summary
The vast majority of cardiac pacemakers are implanted in older people. Pacing is a safe and effective treatment for patients with symptomatic bradyarrhythmias. This review provides a clinician's guide to the essential aspects of modern pacemaker therapy in older patients, including aetiology and epidemiology of bradycardia. We discuss some barriers to access to pacing. We review indications for pacemakers, and describe pacing system function, including the different types of pacemakers used. We also review clinical outcomes following pacing, follow-up requirements and problems encountered in clinical practice. Finally, we discuss ethical and end of life considerations with these devices.
- Type
- Clinical geriatrics
- Information
- Copyright
- Copyright © Cambridge University Press 2011
References
1Birnie, D, Williams, K, Guo, A, Mielniczuk, L, Davis, D, Lemery, R, Green, M, Gollob, M, Tang, A. Reasons for escalating pacemaker implants. Am J Cardiol 2006; 98: 93–97.CrossRefGoogle ScholarPubMed
2James, TN. Normal and abnormal consequences of apoptosis in the human heart. From postnatal morphogenesis to paroxysmal arrhythmias. Circulation 1994; 90: 556–73.CrossRefGoogle ScholarPubMed
3Da Costa, D, Brady, WJ, Edhouse, J. Bradycardias and atrioventricular conduction block. BMJ 2002; 324: 535–38.Google Scholar
4Kojic, EM, Hardarson, T, Sigfusson, N, Sigvaldason, H. The prevalence and prognosis of third-degree atrioventricular conduction block: the Reykjavik Study. J Internal Med 1999; 246: 81–86.CrossRefGoogle ScholarPubMed
5Shaw, DB, Kekwick, CA. Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder (sick sinus syndrome). Br Heart J 1978; 40: 99–105.Google Scholar
7Shiraishi, I, Takamatsu, T, Minamikawa, T, Onouchi, Z, Fujita, S. Quantitative histological analysis of the human sinoatrial node during growth and aging. Circulation 1992; 85: 2176–84.Google Scholar
8Bharati, S, Lev, M. The pathologic changes in the conduction system beyond the age of ninety. Am Heart J 1992; 124: 486–96.Google Scholar
9Rajala, S, Kaltula, K, Haavisyo, M, Mattila, K. Prevalence of ECG findings in very old people. Eur Heart J 1984; 5: 168–74.CrossRefGoogle ScholarPubMed
10Kelley, GP, Stellingworth, MA, Broyles, S, Glancy, DL. Electrocardiographic findings in 888 patients >=90 years of age. Am J Cardiol 2006; 98: 1512–14.Google Scholar
11Lakkireddy, DR, Clark, RA, Mohiuddin, SM. Electrocardiographic findings in patients >100 years of age without clinical evidence of cardiac disease. Am J Cardiol 2003; 92: 1249–51.CrossRefGoogle ScholarPubMed
12Miller, WL, Hodge, DO, Hammill, SC. Association of uncomplicated electrocardiographic conduction blocks with subsequent cardiac morbidity in a community-based population (Olmsted County, Minnesota). Am J Cardiol 2008; 101: 102–6.CrossRefGoogle Scholar
13Vardas, PE, Auricchio, A, Blanc, JJ, Daubert, JC, Drexler, H, Ector, H, Gasparini, M, Linde, C, Morgado, FB, Oto, A, Sutton, R, Trusz-Gluza, M; European Society of Cardiology; European Heart Rhythm Association. Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Europace 2007; 9: 959–98.Google Scholar
14McAnulty, J, Rahimtoola, S, Murphy, E. Natural history of ‘high risk’ bundle branch block: final report of a prospective study. New Engl J Med 1982; 307: 137–43.CrossRefGoogle ScholarPubMed
15Englund, A. Electrophysiological studies in patients with bifascicular block. Thesis, 1995. Karolinska Institute, Stockholm.Google Scholar
16Ector, H, Vardas, P. Current use of pacemakers, implantable cardioverter defibrillators, and resynchronization devices: data from the registry of the European Heart Rhythm Association. Eur Heart J Suppl 2007; 9 (suppl I): I44–I9.Google Scholar
17Network Devices Survey Group (2010). CRM National Clinical Audit 2009. Available at: http://www.devicesurvey.comGoogle Scholar
19Cunnington, MS, Plummer, CJ, McComb, JM. Delays and adverse clinical outcomes associated with unrecognized pacing indications. QJM 2009; 102: 485–90.Google Scholar
20Cunnington, MS, Plummer, CJ, McComb, JM. A survey of investigations performed prior to permanent pacemaker implantation. Age Ageing 2010; 39: 135–39.CrossRefGoogle ScholarPubMed
21McComb, JM, Plummer, CJ. Lack of knowledge of pacemaker indications at the front line. Heart 2007; 93 (suppl 1): A46.Google Scholar
22Epstein, AE, DiMarco, JP, Ellenbogen, KA, Estes, NA 3rd, Freedman, RA, Gettes, LS, Gillinov, AM, Gregoratos, G, Hammill, SC, Hayes, DL, Hlatky, MA, Newby, LK, Page, RL, Schoenfeld, MH, Silka, MJ, Stevenson, LW, Sweeney, MO, Smith, SC Jr, Jacobs, AK, Adams, CD, Anderson, JL, Buller, CE, Creager, MA, Ettinger, SM, Faxon, DP, Halperin, JL, Hiratzka, LF, Hunt, SA, Krumholz, HM, Kushner, FG, Lytle, BW, Nishimura, RA, Ornato, JP, Page, RL, Riegel, B, Tarkington, LG, Yancy, CW; American College of Cardiology /American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices); American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51: e1–62.CrossRefGoogle Scholar
23Siddons, H. Deaths in long-term paced patients. Br Heart J 1974; 36: 1201–9.CrossRefGoogle ScholarPubMed
24Ginks, W, Leatham, A, Siddons, H. Prognosis of patients paced for chronic atrioventricular block. Br Heart J 1979; 41: 633–36.Google Scholar
25Dhingra, RC, Denes, P, Wu, D, Chuquimia, R, Rosen, KM. The significance of second degree atrioventricular block and bundle branch block: observations regarding site and type of block. Circulation 1974; 49: 638–46.Google Scholar
26Shaw, DB, Kekwick, CA, Veale, D, Gowers, J, Whistance, T. Survival in second degree atrioventricular block. Br Heart J 1985; 53: 587–93.Google Scholar
27Shaw, DB, Gowers, JI, Kekwick, CA, New, KHJ, Whistance, AWT. Is Mobitz type I atrioventricular block benign in adults? Heart 2004; 90: 169–74.Google Scholar
28Barold, SS. Indications for permanent cardiac pacing in first-degree AV block: class I, II, or III? Pacing Clin Electrophysiol 1996; 19: 747–51.Google Scholar
29Tabrizi, F, Rosenqvist, M, Bergfeldt, L, Englund, A. Time relation between a syncopal event and documentation of atrioventricular block in patients with bifascicular block: clinical implications. Cardiology 2007; 108: 138–43.Google Scholar
30Kennebäck, G, Tabrizi, F, Lindell, P, Nordlander, R. High-degree atrioventricular block during anti-arrhythmic drug treatment: use of a pacemaker with a bradycardia-detection algorithm to study the time course after drug withdrawal. Europace 2007; 9: 186–91.Google Scholar
31Cunnington, MS, Plummer, CJ, McDiarmid, AK, McComb, JM. The patient journey from symptom onset to pacemaker implantation. QJM 2008; 101: 955–60.Google Scholar
33Kawasaki, R, Machado, C, Reinoehl, J, Fromm, B, Baga, JJ, Steinman, RT, Lehmann, MH. Increased propensity of women to develop torsades de pointes during complete heart block. J Cardiovasc Electrophysiol 1995; 6: 1032–38.Google Scholar
34Shaw, DB, Holman, RR, Gowers, JI. Survival in sinoatrial disorder (sick-sinus syndrome). BMJ 1980; 280: 139–41.Google Scholar
35Thomas, H, Plummer, C, Turley, A, McComb, J. Indications for permanent pacing: the three second pause is an arbitrary and inappropriate discriminator. Unpublished observations, 2010.Google Scholar
36Zeltser, D, Justo, D, Halkin, A, Rosso, R, Ish-Shalom, M, Hochenberg, M, Viskin, S. Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug. J Am Coll Cardiol 2004; 44: 105–8.CrossRefGoogle ScholarPubMed
37Essebag, V, Reynolds, MR, Hadjis, T, Lemery, R, Olshansky, B, Buxton, AE, Josephson, ME, Zimetbaum, P. Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation. Arch Intern Med 2007; 167: 1648–53.Google Scholar
38Essebag, V, Hadjis, TOM, Platt, RW, Abrahamowicz, M, Pilote, L. Effect of amiodarone dose on the risk of permanent pacemaker insertion. Pacing Clin Electrophysiol 2004; 27: 1519–25.Google Scholar
39Essebag, V, Hadjis, T, Platt, RW, Pilote, L. Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction. J Am Coll Cardiol 2003; 41: 249–54.Google Scholar
40Hernandez, RK, Farwell, W, Cantor, MD, Lawler, EV. Cholinesterase inhibitors and incidence of bradycardia in patients with dementia in the veterans affairs new England healthcare system. J Am Geriatr Soc 2009; 57: 1997–2003.Google Scholar
41Gill, SS, Anderson, GM, Fischer, HD, Bell, CM, Li, P, Normand, SL, Rochon, PA. Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Arch Intern Med 2009; 169: 867–73.CrossRefGoogle ScholarPubMed
42Sutton, R, Petersen, MEV. The clinical spectrum of neurocardiogenic syncope. J Cardiovasc Electrophysiol 1995; 6: 569–76.CrossRefGoogle ScholarPubMed
43Grubb, BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 2005; 111: 2997–3006.Google Scholar
44Tan, MP, Parry, SW. Vasovagal syncope in the older patient. J Am Coll Cardiol 2008; 51: 599–606.Google Scholar
45Ammirati, F, Colivicchi, F, Santini, M. Diagnosing syncope in the clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial-the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000; 21: 935–40.CrossRefGoogle Scholar
46Blanc, J, L'Her, C, Touiza, A. Prospective evaluation and outcome of patients admitted for syncope over 1 year period. Eur Heart J 2002; 23: 815–20.CrossRefGoogle Scholar
47Disertori, M, Brignole, M, Menozzi, C et al. . Management of syncope referred for emergency to general hospitals. Europace 2003; 5: 283–91.Google Scholar
48Sud, S, Massel, D, Klein, GJ, Leong-Sit, P, Yee, R, Skanes, AC, Gula, LJ, Krahn, AD. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med 2007; 120: 54–62.Google Scholar
49Sutton, R, Brignole, M, Menozzi, C, Raviele, A, Alboni, P, Giani, P, Moya, A. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. Circulation 2000; 102: 294–99.Google Scholar
50Connolly, SJ, Sheldon, R, Roberts, RS, Gent, M, on Behalf of the Vasovagal Pacemaker Study Investigators. The North American vasovagal pacemaker study (VPS): A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999; 33: 16–20.Google Scholar
51Connolly, SJ, Sheldon, R, Thorpe, KE, Roberts, RS, Ellenbogen, KA, Wilkoff, BL, Morillo, C, Gent, M; VPS II Investigators. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope. JAMA 2003; 289: 2224–29.CrossRefGoogle ScholarPubMed
52Raviele, A, Giada, F, Menozzi, C, Speca, G, Orazi, S, Gasparini, G, Sutton, R, Brignole, M; Vasovagal Syncope and Pacing Trial Investigators. A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004; 25: 1741–48.Google Scholar
53Dey, AB, Stout, NR, Kenny, RA. Cardiovascular syncope is the most common cause of drop attacks in the elderly. Pacing Clin Electrophysiol 1997; 20: 818–19.CrossRefGoogle ScholarPubMed
54Richardson, DA, Bexton, RS, Shaw, FE, Kenny, RA. Prevalence of cardioinhibitory carotid sinus hypersensitivity in patients 50 years or over presenting to the Accident and Emergency Department with ‘unexplained’ or ‘recurrent’ falls. Pacing Clin Electrophysiol 1997; 20: 820–23.Google Scholar
55Parry, SW, Steen, IN, Baptist, M, Kenny, RA. Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentation with falls. J Am Coll Cardiol 2005; 45: 1840–43.Google Scholar
56Brignole, M, Menozzi, C, Lolli, G, Bottoni, N, Gaggioli, G. Long-term outcome of paced and non-paced patients with severe carotid sinus syndrome. Am J Cardiol 1992; 69: 1039–43.Google Scholar
57Kenny, RA, Richardson, DA, Steen, N, Bexton, RS, Shaw, FE, Bond, J. Carotid sinus syndrome: a modifiable risk factor for non-accidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–96.Google Scholar
58Parry, SW, Steen, N, Bexton, RS, Tynan, M, Kenny, RA. Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomised, double-blind, placebo controlled crossover trial. Heart 2009; 95: 405–9.Google Scholar
59Tan, MP, Newton, JL, Reeve, P, Murray, A, Chadwick, TJ, Parry, SW. Results of carotid sinus massage in a tertiary referral unit – is carotid sinus syndrome still relevant? Age Ageing 2009; 38: 680–86.Google Scholar
60McAlister, FA, Ezekowitz, J, Hooton, N, Vandermeer, B, Spooner, C, Dryden, DM, Page, RL, Hlatky, MA, Rowe, BH. Cardiac resynchronization therapy for patients with left ventricular systolic sysfunction. JAMA 2007; 297: 2502–14.Google Scholar
61Yao, G, Freemantle, N, Calvert, MJ, Bryan, S, Daubert, J-C, Cleland, JGF. The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J 2007; 28: 42–51.Google Scholar
62Schmidt, B, Brunner, M, Olschewski, M, Hummel, C, Faber, TS, Grom, A, Giesler, U, Bode, C, Zehender, M. Pacemaker therapy in very elderly patients: long-term survival and prognostic parameters. Am Heart J 2003; 146: 908–13.Google Scholar
63Birnie, DH, Sambell, C, Johansen, H, Williams, K, Lemery, R, Green, MS, Gollob, MH, Lee, DS, Tang, AS. Use of implantable cardioverter defibrillators in Canadian and US survivors of out-of-hospital cardiac arrest. CMAJ 2007; 177: 41–46.Google Scholar
64Toff, WD, Camm, AJ, Skehan, JD. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med 2005; 353: 145–55.Google Scholar
65Lamas, GA, Pashos, CL, Normand, S-LT, McNeil, B. Permanent pacemaker selection and subsequent survival in elderly Medicare pacemaker recipients. Circulation 1995; 91: 1063–69.Google Scholar
66Brady, PA, Shen, WK, Neubauer, SA, Hammill, SC, Hodge, DO, Hayes, DL. Pacing mode and long-term survival in elderly patients with congestive heart failure: 1980–1985. J Interv Card Electrophysiol 1997; 1: 193–201.Google Scholar
67Sweeney, MO, Hellkamp, AS, Ellenbogen, KA, Lamas, GA. Reduced ejection fraction, sudden cardiac death, and heart failure death in the mode selection trial (MOST): implications for device selection in elderly patients with sinus node disease. J Cardiovasc Electrophysiol 2008; 19: 1160–66.Google Scholar
68Lamas, GA, Orav, EJ, Stambler, BS, Ellenbogen, KA, Sgarbossa, EB, Huang, SK, Marinchak, RA, Estes, NA 3rd, Mitchell, GF, Lieberman, EH, Mangione, CM, Goldman, L. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. New Engl J Med 1998; 338: 1097–104.Google Scholar
69Gribbin, GM, Kenny, RA, McCue, P, Toff, WD, Bexton, RS, McComb, JM. Individualised quality of life after pacing. Does mode matter? Europace 2004; 6: 552–60.Google Scholar
70van Hemel, NM, Holwerda, KJ, Slegers, PC, Spierenburg, HA, Timmermans, AA, Meeder, JG, van der Kemp, P, Kelder, JC, Stofmeel, MA; Sensor and Quality of Life (SQL) Investigators. The contribution of rate adaptive pacing with single or dual sensors to health-related quality of life. Europace 2007; 9: 233–38.Google Scholar
71Fleischmann, KE, Orav, EJ, Lamas, GA, Mangione, CM, Schron, E, Lee, KL, Goldman, L. Pacemaker implantation and quality of life in the Mode Selection Trial (MOST). Heart Rhythm 2006; 3: 653–59.Google Scholar
72Gribbin, GM, Gallagher, P, Young, AH, McComb, JM, McCue, P, Toff, WD, Bexton, RS, Bland, JM, Kenny, RA. The effect of pacemaker mode on cognitive function. Heart 2005; 91: 1209–10.Google Scholar
73Castelnuovo, E, Stein, K, Pitt, M, Garside, R, Payne, E. The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation. Health Technol Assess 2005; 9: iii, xi–xiii, 1–246.Google Scholar
74Bernstein, AD, Daubert, JC, Fletcher, RD, Hayes, DL, Lüderitz, B, Reynolds, DW, Schoenfeld, MH, Sutton, R. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol 2002; 25: 260–64.Google Scholar
75Lamas, GA, Orav, EJ, Stambler, BS, Ellenbogen, KA, Sgarbossa, EB, Huang, SK, Marinchak, RA, Estes, NA 3rd, Mitchell, GF, Lieberman, EH, Mangione, CM, Goldman, L. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators. N Engl J Med 1998; 338: 1097–104.Google Scholar
76Connolly, SJ, Kerr, CR, Gent, M, Roberts, RS, Yusuf, S, Gillis, AM, Sami, MH, Talajic, M, Tang, AS, Klein, GJ, Lau, C, Newman, DM. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med 2000; 342: 1385–91.Google Scholar
77Lamas, GA, Lee, KL, Sweeney, MO, Silverman, R, Leon, A, Yee, R, Marinchak, RA, Flaker, G, Schron, E, Orav, EJ, Hellkamp, AS, Greer, S, McAnulty, J, Ellenbogen, K, Ehlert, F, Freedman, RA, Estes, NA 3rd, Greenspon, A, Goldman, L; Mode Selection Trial in Sinus-Node Dysfunction. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002; 346: 1854–62.Google Scholar
78Wilkoff, BL, Cook, JR, Epstein, AE, Greene, HL, Hallstrom, AP, Hsia, H, Kutalek, SP, Sharma, A; Dual Chamber and VVI Implantable Defibrillator Trial Investigators. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288: 3115–23.Google Scholar
79Sweeney, MO, Bank, AJ, Nsah, E, Koullick, M, Zeng, QC, Hettrick, D, Sheldon, T, Lamas, GA; Search AV Extension and Managed Ventricular Pacing for Promoting Atrioventricular Conduction (SAVE PACe) Trial. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node eisease. New Engl J Med 2007; 357: 1000–8.Google Scholar
80Dretzke, J, Toff, WD, Lip, GY, Raftery, J, Fry-Smith, A, Taylor, R. Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block. Cochrane Database Syst Rev 2004; (2): CD003710.Google Scholar
81Winner, S, Boon, N. Clinical problems with temporary pacemakers prior to permanent pacing. J R Coll Physicians Lond 1979; 23:161–63.Google Scholar
82Falk, RH, Zoll, PM, Zoll, RH. Safety and efficacy of non-invasive cardiac pacing. New Engl J Med 1983; 309: 1166–68.Google Scholar
83Zoll, P, Zoll, R, Falk, R, Clinton, J, Eitel, D, Antman, E. External non-invasive temporary cardiac pacing: clinical trials. Circulation 1985; 71: 937–44.Google Scholar
84Betts, TR. Regional survey of temporary transvenous pacing procedures and complications. Postgrad Med J 2003; 79: 463–65.Google Scholar
85Klug, D, Balde, M, Pavin, D, Hidden-Lucet, F, Clementy, J, Sadoul, N, Rey, JL, Lande, G, Lazarus, A, Victor, J, Barnay, C, Grandbastien, B, Kacet, S; PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 2007; 116: 1349–55.CrossRefGoogle ScholarPubMed
86Murphy, JJ. Current practice and complications of temporary transvenous cardiac pacing. BMJ 1996; 312: 1134.Google Scholar
87Osman, F, Krishnamoorthy, S, Nadir, A, Mullin, P, Morley-Davies, A, Creamer, J. Safety and cost-effectiveness of same day permanent pacemaker implantation. Am J Cardiol 2010; 106: 383–85.Google Scholar
88Ellenbogen, KA, Hellkamp, AS, Wilkoff, BL, Camunãs, JL, Love, JC, Hadjis, TA, Lee, KL, Lamas, GA. Complications arising after implantation of DDD pacemakers: the MOST experience. Am J Cardiol 2003; 92: 740–41.Google Scholar
89Healey, J, Armaganijan, L, Nair, G, Morillo, C, Divakaramenon, S, Connolly, S. Risk of complications among elderly recipients of permanent pacemakers. Canadian J Cardiol 2010; 26 (suppl): 424.Google Scholar
90Andersen, HR, Nielsen, JC, Thomsen, PE, Thuesen, L, Mortensen, PT, Vesterlund, T, Pedersen, AK. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997; 350: 1210–16.Google Scholar
91Wilkoff, BL, Auricchio, A, Brugada, J, Cowie, M, Ellenbogen, KA, Gillis, AM, Hayes, DL, Howlett, JG, Kautzner, J, Love, CJ, Morgan, JM, Priori, SG, Reynolds, DW, Schoenfeld, MH, Vardas, PE; Heart Rhythm Society (HRS); European Heart Rhythm Association (EHRA); American College of Cardiology (ACC); American Heart Association (AHA); European Society of Cardiology (ESC); Heart Failure Association of ESC (HFA); Heart Failure Society of America (HFSA). HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): Description of Techniques, Indications, Personnel, Frequency and Ethical Considerations: Developed in partnership with the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA); and in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC), the Heart Failure Association of ESC (HFA), and the Heart Failure Society of America (HFSA). Endorsed by the Heart Rhythm Society, the European Heart Rhythm Association (a registered branch of the ESC), the American College of Cardiology, the American Heart Association. Europace 2008; 10: 707–25.Google Scholar
92Huagui, L, Dhanunjaya, L, Hema, K, Karen, R, Tom, H. Pacemaker utilization during permanent atrial fibrillation in patients who received pacemaker implantation for sinus node dysfunction. Am J Cardiol 2005; 96: 942–45.Google Scholar
93Sgarbossa, EB, Pinski, SL, Jaeger, FJ, Trohman, RG, Maloney, JD. Incidence and predictors of syncope in paced patients with sick sinus syndrome. Pacing Clinl Electrophysiol 1992; 15: 2055–60.Google Scholar
94Pavlovic, SU, Kocovic, D, Djordjevic, M, Belkic, K, Kostic, D, Velimirovic, D. The etiology of syncope in pacemaker patients. Pacing Clin Electrophysiol 1991; 14: 2086–91.Google Scholar
95Brignole, M, Menozzi, C, Lolli, G, Oddone, D, Gianfranchi, L, Bertulla, A. Pacing for carotid sinus syndrome and sick sinus syndrome. Pacing Clin Electrophysiol 1990; 13: 2071–75.Google Scholar
96Skanes, AC, Krahn, AD, Yee, R, Klein, GJ, Connolly, SJ, Kerr, CR, Gent, M, Thorpe, KE, Roberts, RS; Canadian Trial of Physiologic Pacing. Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing. J Am Coll Cardiol 2001; 38: 167–72.Google Scholar
97Toff, WD, Camm, AJ, Skehan, JD. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. New Engl J Med 2005; 353: 145–55.Google Scholar
98Glotzer, TV, Hellkamp, AS, Zimmerman, J, Sweeney, MO, Yee, R, Marinchak, R, Cook, J, Paraschos, A, Love, J, Radoslovich, G, Lee, KL, Lamas, GA; MOST Investigators. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 2003; 107: 1614–19.Google Scholar
99Gage, BF, Waterman, AD, Shannon, W, Boechler, M, Rich, MW, Radford, MJ. Validation of clinical classification schemes for predicting stroke. JAMA 2001; 285: 2864–70.Google Scholar
100Lip, GYH, Nieuwlaat, R, Pisters, R, Lane, DA, Crijns, HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest 2010; 137: 263–72.CrossRefGoogle ScholarPubMed
101Lip, GYH, Frison, L, Halperin, JL, Lane, D. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011; 57: 173–80.Google Scholar
102Mueller, PS, Hook, CC, Hayes, DL. Ethical analysis of withdrawal of pacemaker orimplantable cardioverter-defibrillator support at the end of life. Mayo Clinic Proc 2003; 78: 959–63.Google Scholar
103Lampert, R, Hayes, DL, Annas, GJ, Farley, MA, Goldstein, NE, Hamilton, RM, Kay, GN, Kramer, DB, Mueller, PS, Padeletti, L, Pozuelo, L, Schoenfeld, MH, Vardas, PE, Wiegand, DL, Zellner, R; American College of Cardiology; American Geriatrics Society; American Academy of Hospice and Palliative Medicine, American Heart Association; European Heart Rhythm Association; Hospice and Palliative Nurses Association. HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy: This document was developed in collaboration and endorsed by the American College of Cardiology (ACC), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative Medicine (AAHPM); the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), and the Hospice and Palliative Nurses Association (HPNA). Heart Rhythm: the official journal of the Heart Rhythm Society 2010; 7: 1008–26.Google Scholar
104Gale, C, Mulley, G. Pacemaker explosions in crematoria: problems and possible solutions. J R Soc Med 2002; 95: 353–55.Google Scholar
105Ghosh, D, James, M, Palmer, R. ICD electrical injury on removal of implantable defibrillator after death. Heart 1997; 77: 484–85.Google Scholar