Dean Boddington

Pacemaker Use in New Zealand – Data From the New Zealand Implanted Cardiac Device Registry (ANZACS-QI 15)

BACKGROUND The New Zealand Cardiac Implanted Device Registry (Device) has recently been developed under the auspices of the New Zealand Branch of the Cardiac Society of Australia and New Zealand. This study describes the initial Device registry cohort of patients receiving a new pacemaker, their indications for pacing and their perioperative complications. METHODS The Device Registry was used to audit patients receiving a first pacemaker between 1st January 2014 and 1st June 2015. RESULTS We examined 1611 patients undergoing first pacemaker implantation. Patients were predominantly male (59%), and had a median age of 70 years. The most common symptom for pacemaker implantation was syncope (39%), followed by dizziness (30%) and dyspnoea (12%). The most common aetiology for a pacemaker was a conduction tissue disorder (35%), followed by sinus node dysfunction (22%). Atrioventricular (AV) block was the most common ECG abnormality, present in 44%. Dual chamber pacemakers were most common (62%), followed by single chamber ventricular pacemakers (34%), and cardiac resynchronisation therapy - pacemakers (CRT-P) (2%). Complications within 24hours of the implant procedure were reported in 64 patients (3.9%), none of which were fatal. The most common complication was the need for reoperation to manipulate a lead, occurring in 23 patients (1.4%). CONCLUSION This is the first description of data entered into the Device registry. Patients receiving a pacemaker were younger than in European registries, and there was a low use of CRT-P devices compared to international rates. Complications rates were low and compare favourably to available international data.

Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand.

BACKGROUND We examined equity of access to implanted cardioverter defibrillators (ICDs) in New Zealand in 2010 by district health board (DHB), ethnicity and socioeconomic status. METHODS All new ICD recipients in 2010 were examined according to home district health board, ethnicity according to the national health database, and socioeconomic status using the NZDep index. RESULTS During 2010, 352 new ICDs were implanted nationwide, giving an overall implantation rate of 80.6/million. However, implant rates varied significantly across the 20 DHBs with the highest implant rate observed in Tairawhiti at 192.3/million, and the lowest at 22/million in the Nelson region. There was also significant variation in implant rate by ethnicity, with Maori ethnicity at an implant rate of 114/million, European patients at 83/million, Pacific Island patients at 47/million and Asian patients an implant rate of 32/million. There was no significant difference in number of implants by socioeconomic decile. CONCLUSIONS The variance in implantation rate by district health board and by ethnicity suggests that access to ICD therapy is not equitable in New Zealand. Investigation into causes of inequity of access is required.

Provision of Pacemaker Services to Fiji

procedures were complicated by stroke; one cerebellar stroke with full recovery and one hemiplegic stroke with residual right armweakness and mild dysphasia. 1 patient developed post procedural pericarditis. There were no cases of significant vascular access site bleeding. Conclusion: This series demonstrates the learning curve involved with commencement of performing AF ablation procedures. The procedure carries significant risks as demonstrated and is therefore only recommended for patients with symptoms refractory to antiarrhythmic therapy.