Monitoring patients with permanent cardiac pacemakers.

Patients requiring cardiac pacing are predominantly older citizens with multiple problems, demanding highly skilled monitoring as well as a holistic approach to their care. Pacemaker therapy, though widely accepted, currently is being scrutinized to determine its impact on cost as well as quality. To this end, a Joint American College of Cardiology/American Heart Association Task Force established a subcommittee on pacemaker implantation to define current indications for permanent cardiac pacemakers. The indications have been grouped into three classifications. Class I: conditions for which there is general agreement that permanent pacemakers should be implanted. Class II: conditions for which permanent pacemakers are frequently used but for which there is divergence of opinion with respect to the necessity of their insertion. Class III: conditions for which there is general agreement that pacemakers are unnecessary. It behooves the nurse in clinical practice to review the reference related to the foregoing classification system and to be knowledgeable of the conditions that fall within each group.