Termination of implantable pacemaker therapy: experience in five patients.

BACKGROUND: Established guidelines direct the initial implantation of permanent pacemakers. Elective replacement of these devices is common. However, no guidelines exist for the removal of permanent pacemakers and the termination of long-term cardiac pacing.

OBJECTIVE: To describe the feasibility and safety of terminating cardiac pacing in carefully selected patients.

DESIGN: Case series.

SETTING: University hospital.

PATIENTS: Five adults with permanent pacemakers who were referred for pacemaker replacement or a complication related to cardiac pacing. All patients showed alleviation or reversal of the electric disturbance that originally led to the implantation of the device. The patients had received a pacemaker for a class I or II indication (that is, symptomatic bradycardia or asymptomatic, persistent third-degree atrioventricular block at the level of the atrioventricular node).

INTERVENTION: After an appropriate natural rhythm was documented, pacemakers were removed from all patients.

MEASUREMENTS: Time without recurrence of symptomatic bradycardia.

RESULTS: No patient had recurrent symptomatic bradycardia after 18 to 48 months of clinical follow-up.

CONCLUSIONS: The presence of a permanent pacemaker does not necessarily imply a permanent need for cardiac pacing. Discontinuation of cardiac pacing may be considered in certain patients. Establishing consensus criteria about the potential indications, methods, and timing of the termination of cardiac pacing seems appropriate.