Day case permanent pacing.

Abstract

We have previously reported our preliminary experience of day-case permanent pacing in the United Kingdom. The study has now been extended to 50 patients with follow-up of 22 +/- 4 months. During the study period, all patients referred for permanent pacing, either to the senior author, or as in-hospital transfers, were considered for the study. Forty two percent of patients considered fulfilled inclusion and exclusion criteria, resulting in a total of 50 patients being randomized either to day case or conventional in-patient management. In the first month postimplantation, one patient in each group developed a complication requiring revision of system. Only one further pacing related complication occurred over the follow-up period, percutaneous extrusion of a fixation sleeve with spontaneously healing of the wound. This was in a day-case patient. Mean duration of in-patient stay was 5.7 hours in day-case patients, compared with 70.0 hours in those managed conventionally. Postimplantation local physician consultation rates were equal in both groups. Questionnaires were used to determine the relative acceptability to patients of the two management protocols; on a ten point score of acceptability, the mean score for both groups was 8.8. The difference in cost per patient using day-case management was approximately 430 ($817) pounds. We conclude that day-case permanent pacing in the United Kingdom is feasible, acceptable to patients, and has considerable economic benefits.