Pacemaker clinic evaluations: key to early identification of surgical problems.

The pacemaker center evaluation was responsible for the timely reoperation of 341 pacemaker patients over the last three years. The most common indication for reoperation was battery end-of-service (46.3%). Battery testing and maintenance of accurate records for trend analysis ensures prompt generator replacement. Atrial and/or ventricular lead malfunction was the second largest indication (26.3%). Lead malfunction detected by bracketing capture and sensing thresholds included: dislodgement, penetration, exit block, fracture, insulation failure, and abnormal sensing. The third largest indication for reoperation was pacemaker pocket erosion and/or infection (15.5%). Examination of the pacemaker pocket site is an integral part of an evaluation. In conclusion, the three largest indications for reoperations can be best demonstrated in a pacemaker center where evaluations are personal and thorough, and accurate record keeping is maintained.