Office Evaluation of the Pacemaker Patient

IN THE third decade of cardiac pacemaker therapy, more than 500,000 patients in the United States alone live with the aid of a permanent pacemaker. It has been estimated that over 100,000 new pacing systems will be implanted in 1985.¹The proliferation of technologic advances has resulted in an increasing frequency of implantation of multiprogrammable, dual-chamber pacing systems. Although pacemaker programming (Table 1) and telemetric monitoring remain in the domain of the experienced cardiologist, it behooves every physician to recognize normal and abnormal pacemaker function. It has been suggested that pacemaker malfunction can be detected by history and electrocardiography in 99% of patients.²,³This review will focus on the basic office evaluation of patients with pacemakers, using equipment readily available in the internist's office. Discussion of the radiology of pacing systems (to detect lead position[s] and fracture), principles of transtelephonic monitoring, and description of antitachycardia and defibrillating devices