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Follow up and optimisation of cardiac pacing
  1. Paul R Roberts
  1. Correspondence to:
    Dr Paul R Roberts
    Southampton University Hospital, Tremona Road, Southampton. SO16 6YD, UK;

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Pacemaker implantation is only the initial phase in the lifelong management of the patient with a pacemaker. The challenge of this treatment lies in the comprehensive follow up of the device. As the number of implanted devices increases so does the burden of follow up. This is compounded by increasing data provided by devices and increasing sophistication in programming therapy and detection algorithms. There are some general guidelines on pacemaker follow up provided by national organisations, but very little provided in the way of detail.1,2 This is reflected in the immense variation in the manner of pacemaker follow up both nationally and internationally. Like most medical interventions pacemaker follow up has to be tailored to the individual. The fundamental principles of pacemaker follow up are listed in table 1.

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Table 1

 Fundamental principles of pacemaker follow up


In order to follow up patients with implanted devices adequately there has to be a basic resource provision in terms of real estate, equipment, and appropriately trained personnel. A dedicated area for pacemaker follow up should be provided which enables the patient to have their appointment performed in privacy and safety. Full resuscitation facilities should be immediately available, though recourse to resuscitation facilities as a direct consequence of a pacemaker follow up is extremely rare. Relevant pacemaker programmers and appropriate technical information for all followed pacemakers should be available. A comprehensive list of basic required equipment is described in table 2. Pacemaker follow up is increasingly performed by non-medical staff such as cardiac physiologists (technicians) and nursing staff. The facility should exist in these circumstances for the patients to have access to medical input in the event of an emergency or problematic follow up. There should be a basic competency level of those staff performing follow up. This level is often defined at …

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  • Competing interest: Paul Roberts is in receipt of research funding, occasional consultancy fees and support for conference attendance from pacemaker manufacturers (Guidant, Medtronic, St Jude, Sorin-ELA). In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article