[Selection of the optimal pacemaker - Are age and secondary disease related health conditions significant?].

UNLABELLED: In pacemaker statistics a dichotomy exists between the theoretically possible and the actually implanted number of physiological pacemakers. Hence, the aim of the study was to investigate the influences of age and non rhythm related health conditions on the selection of the pacemaker system.In 468 pacemaker patients the arguments for mode selection at first implantation were listed prospectively during a period of 3 years and 9 months. Mode selection followed electrocardiographic (recommendations of the German working Group on Cardiac Pacing), clinical (incidence of only intermittent bradycardias, stage of the underlying cardiac or of a second noncardiac disease) and sociomedical (non rhythm related general heath condition) aspects. Regarding the ECG findings physiological pacing was possible in 329 cases. Nevertheless, 57 of them (17.3%) received a VVI(R) system. Analysis of the reasoning leading to this dicision demonstrated that age-related problems and non-rhythm-caused health conditions became superior instead of rhythmologic aspects in 1.0% of all patients (pts) under 70, in 2.7% of all pts between 70 and 79, and in 10.8% of all pts 80 or more years of age. CONCLUSIONS: Beyond the age of 80 years, in about 11% of the pts who need a pacemaker, non-rhythm-related clinical and sociomedical aspects gain priority over the electrophysiologic defect. Thus, complete coincidence of the theoretically possible and the actually implanted number of physiological pacemakers in this age group cannot be attained. Regarding all factors influencing the selection of the pacemaker system 45 to 55% are more realistic.