The establishment of a local permanent pacemaker service in a district general hospital increased the pacemaker implantation rate from 22 per million population per year to 152 per million population per year over the first 6 years of the service. Forty eight per cent of patients were referred by general practitioners and 52% by hospital specialists. Single chamber demand pacing (VVI) was used exclusively. Indications for pacing and complications were comparable to those of specialist cardiac centres. Management of symptomatic bradycardia by cardiac pacing in the United Kingdom may be facilitated by further development of small pacing centres.
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