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Larsen 2016
Larsen 2016
of Pages 5
Received 7 March 2016; received in revised form 30 May 2016; accepted 1 June 2016; online published-ahead-of-print xxx
Background The New Zealand Cardiac Implanted Device Registry (Device) has recently been developed under the
auspices of the New Zealand Branch of the Cardiac Society of Australia and New Zealand. This study
describes the initial Device registry cohort of patients receiving a new pacemaker, their indications for
pacing and their perioperative complications.
Methods The Device Registry was used to audit patients receiving a first pacemaker between 1st January 2014 and 1st
June 2015.
Results We examined 1611 patients undergoing first pacemaker implantation. Patients were predominantly male
(59%), and had a median age of 70 years. The most common symptom for pacemaker implantation was
syncope (39%), followed by dizziness (30%) and dyspnoea (12%). The most common aetiology for a pace-
maker was a conduction tissue disorder (35%), followed by sinus node dysfunction (22%). Atrioventricular
(AV) block was the most common ECG abnormality, present in 44%. Dual chamber pacemakers were most
common (62%), followed by single chamber ventricular pacemakers (34%), and cardiac resynchronisation
therapy – pacemakers (CRT-P) (2%). Complications within 24 hours of the implant procedure were reported
in 64 patients (3.9%), none of which were fatal. The most common complication was the need for reoperation
to manipulate a lead, occurring in 23 patients (1.4%).
*Corresponding author at: University of Otago, Wellington PO Box 7343 Wellington New Zealand Tel.: +64 4 9185103; fax: +64 4 3895318,
Email: peter.larsen@otago.ac.nz
© 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V.
All rights reserved.
Please cite this article in press as: Larsen PD, et al. Pacemaker Use in New Zealand – Data From the New Zealand Implanted
Cardiac Device Registry (ANZACS-QI 15). Heart, Lung and Circulation (2016), http://dx.doi.org/10.1016/j.hlc.2016.06.1206
HLC 2157 No. of Pages 5
Conclusion This is the first description of data entered into the Device registry. Patients receiving a pacemaker were
younger than in European registries, and there was a low use of CRT-P devices compared to international
rates. Complications rates were low and compare favourably to available international data.
Keywords Cardiac pacemakers Pacemaker leads Registry
Please cite this article in press as: Larsen PD, et al. Pacemaker Use in New Zealand – Data From the New Zealand Implanted
Cardiac Device Registry (ANZACS-QI 15). Heart, Lung and Circulation (2016), http://dx.doi.org/10.1016/j.hlc.2016.06.1206
HLC 2157 No. of Pages 5
Pacemaker Use in New Zealand – Data From the New Zealand Implanted Cardiac Device Registry (ANZACS-QI 15) 3
AAI = single chamber pacing in the atria, VVI = single chamber pacing in the ventricle, DDD = dual chamber AV sequential pacing with two leads, DDI = dual
chamber pacing, inhibited by atrial sensing, AAI/DDD single chamber atrial pacing with automatic mode switching to dual chamber pacing, CRT-P = cardiac
resynchronisation therapy – pacemaker.
Please cite this article in press as: Larsen PD, et al. Pacemaker Use in New Zealand – Data From the New Zealand Implanted
Cardiac Device Registry (ANZACS-QI 15). Heart, Lung and Circulation (2016), http://dx.doi.org/10.1016/j.hlc.2016.06.1206
HLC 2157 No. of Pages 5
fatal. The most common complication was the need for reop- 4.3% in Norway [9] 4% in Australia [2] and 1.8% in an Italian
eration to manipulate a lead, occurring in 23 patients (1.4%). registry 1.8% [7]. Most of the cohort of patients receiving a
In 57% of these cases the atrial lead required reoperation, and CRT-P device in our study had significantly impaired left
the ventricular lead in 43%. Twenty of the 23 (87%) lead ventricular function, with an LVEF of less than 30% in
reoperations occurred in patients with dual chamber devices, 56%, and less than 35% in 81%. This could suggest that some
one in a patient with CRT-P and two in single chamber of these patients may fulfil criteria for a primary prevention
devices. Haematoma requiring some form of intervention ICD[10]. However, the registry does not collect data on contra-
was reported in 12 cases (0.7%), and in four cases (0.2%) indications, so further investigation into the choice of CRT-P
there was some other form of access site complication. A over CRT-D in this patient group would be required to exam-
pneumothorax was reported in five cases (0.3%), and hae- ine the appropriateness of device selection in this group.
modynamic instability in three cases (0.2%). There was one The overall complication rate observed in this study was
coronary sinus dissection and one myocardial perforation, 3.9%. Comparison with international series is difficult, due to
and nine other complications. the absence of standard definitions of complications, and
variance in the timeframe over which complications are
examined. Complication rates of 12.4% at two months[11],
7.7% at three months[12] and 5.3% at one year [5] have been
Discussion reported in recent series. The most common complication in
This is the first report from the New Zealand Implanted our series was lead dislodgement requiring reoperation,
Cardiac Device registry, and describes patient characteristics, occurring in 1.4%. This is a slightly lower rate than 2.2%–
indications for pacing and perioperative complications for 3.7% reported in other series[5,11,12]. While the majority of
1611 new pacemaker implantations over an 18-month period. lead dislodgements in these other series occurred early, there
This is the first multicentre description of patients receiving were also dislodgements beyond the first 24 hours in each.
pacemakers in New Zealand. The median age of pacemaker This data is not captured in our dataset. There is intent to
patients was 70, and 59% were male. The most common collect complications at one month within our registry, and
symptom indications for pacing were syncope and dizziness this will be important to establish a more complete picture of
and the most common ECG indications for pacing were AV early complications associated with pacemaker implantation.
block and sick sinus syndrome. The underlying aetiologies The rates of pneumothorax and myocardial perforation were
were conduction tissue disorder and sinus node dysfunction. slightly lower in our series compared to recent publications
Perioperative complications occurred in 3.9%, most com- [5,11–13]. New Zealand has a relatively small group of highly
monly the need for reoperation to manipulate a lead. experienced cardiologists undertaking device implantation,
During the first 18 months of use of the Device registry, data and it is possible that this contributes to the low complication
for 1611 new pacemakers were entered into the registry. Eight rate, as experience has been associated with a lower rate of
of the 10 implanting centres in New Zealand contributed complications[14].
patients to the registry, and based on 2013[2] survey data, Future directions: The Device registry is supported by the
the registry is likely to represent 60 to 65% of all new pace- New Zealand National Cardiac Clinical Network and Heart
makers implanted in New Zealand during this time period. Rhythm NZ for use to capture all pacemaker and ICD
Patients were slightly younger than in European registries, implants in NZ public hospitals. In centres using the registry
with a median age of 70 years, compared to 76 years in comprehensively, the hospital level summary Device reports
Sweden[5], 77 years in Spain[6] and 80 years in Italy[7]. While generated from the ANZACS-QI platform are being used by
an implantation rate cannot be accurately determined from clinicians for local audit and quality improvement purposes.
our dataset, previous surveys describe a substantially lower It is intended that within a year all centres will comprehen-
rate of implantation of new pacemakers in New Zealand sively capture and report implantation using this registry.
(367/million) than in Australia (652/million) in 2013[2]. In
2011 the average European implant rate was 604/million[8].
The low average age of pacemaker recipients and the low
implant rate together may indicate reduced access to pace-
Limitations
maker therapy in the elderly in New Zealand compared to This study is a descriptive report of data collected by the New
other health systems. Zealand Implanted Cardiac Devices registry. This registry is
The most common ECG finding was AVB, with complete voluntary, and there is no routine audit to determine overall
heart block observed in 29% of cases, followed by sick sinus levels of accuracy of data entered; therefore, data needs to be
syndrome. This is consistent with observations from interna- interpreted with some caution. In addition, the proportion of
tional registries[5–7]. The most common symptom presenta- patients entered into the registry by participating hospitals is
tions were syncope and dizziness, in keeping with not monitored. This currently limits our ability to examine
international pacemaker registries[5–7]. implant rates and to examine equity of access to pacemaker
The proportion of CRT-P devices was relatively low com- therapy across the country. The Device registry allows cap-
pared to international registries. In 2013 8.5% of new pace- ture of post-discharge complications, but currently many of
makers in the UK were CRT-P [9], 4.5% in the Netherlands [9], the records are incomplete and this data has therefore not
Please cite this article in press as: Larsen PD, et al. Pacemaker Use in New Zealand – Data From the New Zealand Implanted
Cardiac Device Registry (ANZACS-QI 15). Heart, Lung and Circulation (2016), http://dx.doi.org/10.1016/j.hlc.2016.06.1206
HLC 2157 No. of Pages 5
Pacemaker Use in New Zealand – Data From the New Zealand Implanted Cardiac Device Registry (ANZACS-QI 15) 5
Please cite this article in press as: Larsen PD, et al. Pacemaker Use in New Zealand – Data From the New Zealand Implanted
Cardiac Device Registry (ANZACS-QI 15). Heart, Lung and Circulation (2016), http://dx.doi.org/10.1016/j.hlc.2016.06.1206