[Patients with implanted pacemakers in the primary hospital and stay under the care of an outpatient cardiology clinic--differences in comparison with the reference center].

UNLABELLED: The aim of the study was to find an answer for a question whether a newly created primary centre ensures the same level of safety as a reference centre in terms of complications of pacemaker implantation and whether the outpatient care of patients with an implanted pacemaker is as competent as in a reference centre. MATERIAL AND METHODS. The analysis of documentation of the patients (274 pts, 135 men, mean age = 74 + 9 years) who underwent implantation of a permanent single (VVI, 222pts) or dual-chamber (DDD, 52pts) pacemaker at the department of cardiology of the primary centre compared to the reference centre (80 pts) at the department of cardiology. The following data was analyzed: gender, age, length of hospitalization, type of pacemaker, type of electrode, place of pacing, indications for permanent pacing, co-existing diseases, periprocedural complications, complications, technique of electrode implantation and the type of electrode fixation.

RESULTS

Patients who underwent implantation of a pacemaker in the primary centre were hospitalized longer than those treated in the reference centre, p < 0.001. The technique of subclavian venipuncture used to implant the passive endocardial electrode was more common in the primary centre, p = 0.034. The number of complications after implantation of pacemaker was not significantly statistically. The technique of electrode implantation has a statistically significant effect on the number of complications (OR = 0.11, p < 0.04). Subclavian venipuncture was associated with a statistically significantly higher incidence of pneumothorax (p < 0.019). The type of pacemaker, electrodes or indication for implantation did not have a statistically significant influence on the complications. The patients with ischemic heart disease and myocardial infarction are the most exposed to the complications (OR = 3.73, p < 0.03). All check-ups at the primary centre were carried out by a physician who used suitable programmers. Most visits in the reference centre were carried out by a technician who used the "IMPULS-BIS" set. Pacemaker implantation costs were directly connected with the duration of hospitalization. CONCLUSIONS. High percentage of ventricular stimulation, stimulation of the apex of the right ventricle, the application of passive electrode, avoiding the use of cephalic vein indicates further the need deepen cooperation between centers. Outpatient care of patients with an implanted pacemaker in the primary centre was as competent as in the reference centre. Pacemaker implantation costs are directly connected with the duration of hospitalisation.