The selection of pacing modalities according to NICE recommendations

Abstract

The National Institute for Health and Clinical Excellence (NICE) recommends the use of dual-chamber pacemakers for all bradycardic patients except in a few situations. We aimed to compare our performance to the then new national guidelines. We retrospectively studied the data of all 200 patients who received single-chamber ventricular pacemakers and dual-chamber pacemakers between January 2003 and December 2005 inclusive. Pacemakers were selected based on local opinions prior to the formal adoption of NICE guidelines. In retrospect, our compliance to the guidance was 72%. Of this 72% of patients, 12% were symptomatic at one year, compared with 21% from the noncompliant group (p=0.12). In terms of mortality, 2% of the patients from the compliant group died, compared with 5% from the non-compliant group (p=0.36). Multiple factors influence clinical judgements in selecting a pacing modality. Stringent compliance with the current NICE recommendations may not necessarily reduce mortality and morbidity.

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