Influence of telephone surveillance on pacemaker patient care.

Predictable and unpredictable complications attend long-term pacemaker therapy. Telephone electrocardiographic surveillance of pacemaker patients often reveals an unexpected increase in pacemaker system malfunction. This apparent increase probably more nearly reflects the true incidence of pacemaker system malfunction. Industry claims of pacemaker reliability are misleading because of incomplete retrieval of out-of-use generators. Total pacemaker experience at the Medical College of Georgia from August, 1963, to April, 1979, was analyzed to determine survival, complications, frequency of symptoms of malfunction, and effectiveness of follow-up technique in 490 patients over a 300 mile radius. From October, 1976, to April, 1979, a telephone surveillance system (TSS) monitored 3,623 paced months in 216 patients. This period was compared to 14,307 paced months of follow-up without TSS in all previous patients. Average duration of HgZn generator life was 43 months in TSS patients and 25 months in non-TSS patients. Lithium-powered generators have been monitored since September, 1977; the oldest was only 19 months. TSS detected 82 complications of pacing systems, asymptomatic in 60 patients; 58 patients required reoperation. For an additional 49 patients, referring physicians were notified of arrhythmias, congestive failure, and other potentially serious developments. Because of infrequent follow-up in non-TSS patients, only symptomatic complications which resulted in 645 reoperations can be documented from chart review. The risk of death in TSS patients was 0.8% per month, compared to 1.4% per month in non-TSS patients. Risk of reoperation was 1.6% per month in TSS patients and 4.5% per month in non-TSS patients. Generator replacement occurred at a rate of 0.9% per month in TSS patients compared to 2.8% per month in non-TSS patients. Leads were manipulated or replaced at a rate of 0.5% per month in TSS patients and 1.4% per month in non-TSS patients. TSS contributed toward improved patient safety, extended patient survival, prolonged generator usefulness, and fewer operations in patients with pacemakers.