The selection of pacing modalities according to NICE recommendations

The  National  Institute  for  Health  and  Clinical  Excellence  (NICE) recommends  the  use  of  dual-chamber  pacemakers  for  all  bradycardic  patients except in a few situations. We aimed to compare our performance to the then new national guidelines. We retrospectively studied the data of all 200 patients who   received   single-chamber   ventricular   pacemakers   and   dual-chamber pacemakers  between  January  2003  and  December  2005  inclusive.  Pacemakers were  selected  based  on  local  opinions  prior  to  the  formal  adoption  of  NICE guidelines. In retrospect, our compliance to the guidance was 72%. Of this 72% of patients, 12% were symptomatic at one year, compared with 21% from the non-compliant  group  (p=0.12).  In  terms  of  mortality,  2%  of  the  patients  from  the compliant group died, compared with 5% from the non-compliant group (p=0.36). Multiple  factors  influence  clinical  judgements  in  selecting  a  pacing  modality. Stringent   compliance   with   the   current   NICE   recommendations   may   not necessarily reduce mortality and morbidity.