Elderly and patients with sick sinus syndrome have lower chances for appropriate pacemaker mode selection, according to the Polish Cardiac Society recommendations -- a single-centre retrospective analysis.
BACKGROUND: The Polish Cardiac Society recommendations for permanent heart pacing have been valid since 1999. The clinical use of these guidelines is, however, still limited. AIM: To analyse whether the chosen pacing strategy is consistent with the Polish Cardiac Society recommendations and to estimate the effects of analysed factors on selecting optimal or suboptimal pacing modes. METHOD: Retrospective analysis of medical records and procedure protocols of 1052 patients who underwent pacemaker implantation between 1 January 2000 and 31 December 2004 was performed. In each case, the applied pacing mode was compared against the optimal one defined according to the guidelines of the Polish Cardiac Society. A number of demographic and clinical factors associated with the procedure were analysed and correlated with the optimal pacing mode selection. RESULTS: During the analysed period, 59.3% of patients received optimal pacing. The percentage of patients with optimal pacing increased in the consecutive years from 40.2% in 2000 to 68.5% in 2005. In a univariate regression analysis, patients above the age of 70 years, with sick sinus syndrome as an indication for pacing, as well as cardiac heart failure and obesity, received optimal pacing significantly less frequently. In a multivariate analysis, advanced age and sick sinus syndrome were found to be independent predictors of suboptimal pacing. CONCLUSIONS: About 60% of patients had their pacemakers implanted with the optimal pacing mode selection according to the valid recommendations. Patients over the age of 70 years, as well as patients with sick sinus syndrome, had significantly lower chances of receiving optimal pacing.