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October 11, 1985, Vol 254, No. 14 >
ARTICLE | October 11, 1985

The Use of Cardiac Pacemakers in Medical Practice: Title and subTitle BreakExcerpts From the Report of the Advisory Panel FREE

[+] Author Affiliations

Report C of the Council on Scientific Affairs, adopted by the House of Delegates of the American Medical Association at the Annual Meeting, June 1984.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of scientific experts and reports in the scientific literature as of July 1984.

Reprint requests to the Division of Drugs and Technology, Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (John C. Ballin, PhD).


JAMA. 1985;254(14):1952-1954. doi:10.1001/jama.1985.03360140110036
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References

IN SEPTEMBER 1982, the Senate Select Committee on Aging reported on a year-long investigation of problems related to the purchase and use of pacemakers under Medicare coverage.1 Questions were raised about device performance, application of warranty provisions, cost of pacemaker therapy, and medical reimbursement policies. Other issues opened to query included alleged overutilization of pacemakers, the increasing proficiency needed by physicians who perform pacemaker implantations, the role of the pacemaker sales representative in dealing with the medical profession, and the essential equipment and skilled personnel required for pacemaker implantation facilities. The Senate committee recommended reestablishment of the pacemaker registry sponsored by the Food and Drug Administration until it was discontinued in 1980. The committee suggested that pacemaker centers be established to treat patients who need more difficult or complex pacemaker instrumentation.

In 1982, the Inspector General of the Department of Health and Human Services reviewed the Veterans Administration's experience

REFERENCES

1 +
Editor's Comment (H.D.M.): 2-1 or 3-1 conduction may be due to a block localized in the A-V node (narrow QRS). Under such conditions, it is a variation of Mobitz type I and is usually a benign asymptomatic condition, and, therefore, a very rare, if ever, indication for pacing. 2-1 or 3-1 conduction may also be due to a block in the bundle-branch system; it therefore may be a variation of Mobitz type II block and is often symptomatic, and, therefore, is a common justification for pacemaking implantation.
2 +
Fraud, Waste and Abuse in the Medicare Pacemaker Industry , US Senate staff report. Washington, DC, Special Committee on Aging, 1982;.
3 +
More Efficient Procurement of Heart Pacemakers Could Result in Medicare Savings of Over $64 Million Annually , US Dept of Health and Human Services, Office of Inspector General, 1984;.
4 +
Frye RL, Collins JJ, DeSanctis RW, et al:  Guidelines for permanent cardiac pacemaker implantation, May 1984: A report of the Joint American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Pacemaker Implantation) . Circulation 1984;; 70:331A-339A.
5 +
Parsonnet V, Furman S, Smyth NPD, et al:  Special report of the Intersociety Commission for Heart Disease Resources: Optimal resources for implantable cardiac pacemakers . Circulation 1983;;68:226A-244A.
6 +
Chokshi AB, Friedman HS, Malach M, et al:  Impact of peer review in reduction of permanent pacemaker implantations . JAMA 1981;;246:754-757.
7 +
Scheinman MM, Peters RW, Sauve' MJ, et al:  Value of H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing . Am J Cardiol 1982;;50:1316-1322.
8 +
Dhingra RC, Palileo E, Strasberg B, et al:  Significance of H-V interval of 517 patients with chronic bifascicular block . Circulation 1981;; 64:1265-1270.
9 +
Morley CA, Perrins EJ, Grant P, et al:  Carotid sinus syncope treated by pacing: Analysis of persistent symptoms and role of atrioventricular sequential pacing . Br Heart J 1982;; 47:411-418.
10 +
Crook B, Kitson D, McCornish M, et al:  What is the role of clinical electrophysiology in evaluation of patients with sinoatrial disease? Br Heart J 1976;;38:879-880.
11 +
Selzer A:  Too many pacemakers . N Engl J Med 1982;;307:183.
12 +
Goldberg E:  Symposium on pacemaker utilization practices: How does our garden grow? PACE 1981;;4:230-231.
13 +
Parsonnet V:  The proliferation of cardiac pacing: Medical, technical, and socioeconomic dilemmas . Circulation 1982;;65:841-845.

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1 +
Editor's Comment (H.D.M.): 2-1 or 3-1 conduction may be due to a block localized in the A-V node (narrow QRS). Under such conditions, it is a variation of Mobitz type I and is usually a benign asymptomatic condition, and, therefore, a very rare, if ever, indication for pacing. 2-1 or 3-1 conduction may also be due to a block in the bundle-branch system; it therefore may be a variation of Mobitz type II block and is often symptomatic, and, therefore, is a common justification for pacemaking implantation.
2 +
Fraud, Waste and Abuse in the Medicare Pacemaker Industry , US Senate staff report. Washington, DC, Special Committee on Aging, 1982;.
3 +
More Efficient Procurement of Heart Pacemakers Could Result in Medicare Savings of Over $64 Million Annually , US Dept of Health and Human Services, Office of Inspector General, 1984;.
4 +
Frye RL, Collins JJ, DeSanctis RW, et al:  Guidelines for permanent cardiac pacemaker implantation, May 1984: A report of the Joint American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Pacemaker Implantation) . Circulation 1984;; 70:331A-339A.
5 +
Parsonnet V, Furman S, Smyth NPD, et al:  Special report of the Intersociety Commission for Heart Disease Resources: Optimal resources for implantable cardiac pacemakers . Circulation 1983;;68:226A-244A.
6 +
Chokshi AB, Friedman HS, Malach M, et al:  Impact of peer review in reduction of permanent pacemaker implantations . JAMA 1981;;246:754-757.
7 +
Scheinman MM, Peters RW, Sauve' MJ, et al:  Value of H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing . Am J Cardiol 1982;;50:1316-1322.
8 +
Dhingra RC, Palileo E, Strasberg B, et al:  Significance of H-V interval of 517 patients with chronic bifascicular block . Circulation 1981;; 64:1265-1270.
9 +
Morley CA, Perrins EJ, Grant P, et al:  Carotid sinus syncope treated by pacing: Analysis of persistent symptoms and role of atrioventricular sequential pacing . Br Heart J 1982;; 47:411-418.
10 +
Crook B, Kitson D, McCornish M, et al:  What is the role of clinical electrophysiology in evaluation of patients with sinoatrial disease? Br Heart J 1976;;38:879-880.
11 +
Selzer A:  Too many pacemakers . N Engl J Med 1982;;307:183.
12 +
Goldberg E:  Symposium on pacemaker utilization practices: How does our garden grow? PACE 1981;;4:230-231.
13 +
Parsonnet V:  The proliferation of cardiac pacing: Medical, technical, and socioeconomic dilemmas . Circulation 1982;;65:841-845.

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