Survey of cardiac pacing in Canada (1993).

INTRODUCTION: The status of cardiac pacing in Canada in 1993 was determined from data provided by 33 of 128 physicians surveyed (25% response) and four major manufacturer/distributors. DEMOGRAPHICS: There were 268 new implants per million population, similar to the 1989 data, 279 per million. INDICATIONS: Sinus node disorders accounted for 38.2% of implants, atrial fibrillation with slow ventricular response for 18.1% and atrioventricular node dysfunction for 33.1% of patients. Implants for tachyarrhythmias accounted for only 3.5%. TECHNOLOGY: Single chamber units were implanted in 76% of patients and dual chamber in 23%, with rate modulation used in 35% of primary implants. There was an increase in the use of single chamber rate adaptive units from 1989 (from 15.9% to 25%). The per venous sheath introducer technique was used in 55% of lead insertions. Bipolar leads were used in 78% of atrial and 63% of ventricular leads; passive steroid leads were used in 50% of atrial and 55% of ventricular lead implants; 40% of atrial leads and 7.5% of ventricular leads had active fixation. FOLLOW-UP: Most pulse generators were reprogrammed peri-operatively or within three months (97.4%). Most patients with new implants (92%) required hospital admission for 2.5 days, while 75% of replacements were out-patient procedures. CONCLUSIONS: Comparison with previous surveys and other countries revealed little growth in pacemaker sales or new implant rates per million population; conservative indications and relatively constant use of dual chamber devices; and an increase in single chamber rate responsive units. The authors express concern regarding budget constraints and resource availability as factors limiting growth in pacemaker therapy.