SURVEY OF CARDIAC PACING IN THE UNITED-STATES IN 1989

A survey of physicians who implant permanent cardiac pacemakers was conducted to identify practice patterns related to pacemaker-implantation frequency, hospital and implantation-facility characteristics, indications for pacing and pulse-generator replacement, preferences regarding device types, pacing modes, follow-up methods and frequency, and type and frequency of pacing-related complications. Questionnaires were sent to 11,414 potential physician respondents and 6 pacemaker manufacturers. Implanters' opinions were solicited regarding such issues as the importance of various device features and capabilities, the appropriateness of practice guidelines, and the efficacy of quality-assurance measures. In 1989, 89,445 primary pacemaker implantations and 21,055 pulse-generator replacements were performed by approximately 7,919 physicians at about 3,400 U.S. centers. Typically, a pacemaker manufacturer's sales representative played an active role in 80% of cases. Since the last survey, which examined pacing practices in 1985, primary implantations of dual-chamber pacemakers increased from 22 to 32%, and the proportion of adaptive-rate pacemakers increased from 1 to 40% of primary implants. The "typical" implanter used bipolar electrode systems in 90% of cases, single-chamber pacemakers in 70%, and the introducer method in 95% of lead placements. Significant differences in practice patterns were found among subsets of the survey respondents. Surgeons tended to work alone, use simpler, single-chamber pacemakers, and leave follow-up to others. Electrode stability tended to be better among implanters in nonacademic environments. The quadrennial survey continues to provide useful information on an easily identifiable and traceable patient population, but the process would be greatly simplified by the adoption of a "universal" reporting system such as that used in Europe.