Cardiac pacing in an elderly population with a satellite clinic in a district general hospital.

It has been suggested that in the United Kingdom the rate of implantation of cardiac pacemakers is too low. One possible reason for this may be the inadequate availability or usage of ambulatory ECG monitoring services for elderly patients. Since the introduction of such a service in Crawley, West Sussex, pacemaker implantation has increased from less than five to more than 20 per annum. Ninety-five of the 102 pacemakers (93%) implanted in that time were in patients over the age of 65 years and 68 of them were over 70 years. This rate of implantation is equivalent over the nation as a whole to at least 8000 new pacemakers per year. This represents a 14-23% increase over the present implantation rate. Since all patients were symptomatically improved and survived on average more than 30 months, despite their advanced ages, pacemaker implantation was certainly justified. The establishment of a local pacemaker surveillance service reduced the need for elderly patients to travel long distances for pacemaker checks.