Decision Model May Guide Pacemaker Replacement

Model is aimed at improving management of patients with recalled pacemakers and ICDs

THURSDAY, July 27 (HealthDay News) -- A new decision model may help physicians decide whether or not to replace a pacemaker or an implantable cardioverter defibrillator (ICD) when a device advisory is issued, according to an article published in the July 26 issue of the Journal of the American Medical Association.

Mitesh S. Amin, M.D., of the Virginia Commonwealth University Medical Center in Richmond, and colleagues constructed a decision model to evaluate the risks and benefits associated with immediate device replacement versus continued monitoring.

The researchers found that device replacement is usually warranted in pacemaker-dependent patients when a device failure rate exceeds 0.3 percent and in patients with ICDs for primary or secondary prevention when the rate exceeds 3 percent.

"As the number of implantable devices increase, device failures and advisories will remain a part of routine practice," the authors conclude. "Having a rational mechanism to approach these patients is critical to patient care. The risks of replacing devices are not insignificant and outweigh all but very high risks of death due to device malfunction."

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