40 years of electrostimulation of the heart in Slovenia 1965–2005
Background: Permanent cardiac pacing has since the very rudimentary beginnings in 1950. evolved into an autonomous field. Miniaturization of pacemakers and electrodes paved the way toward the application of less invasive implantation techniques, implementation of computer technology, broadened the list of indications for implantation, increased reliability and longevity and finally, enabled followup and reprogramming of pacemakers to better tailor pacing to the patients’ needs. Evidently, the electrostimulation of the heart resulted in nearly physiologic functioning of the heart greatly improving the quality of life. The aim of the following review is to present the development of electrostimulation of the heart in Ljubljana from the very beginnings in 1965 till today. We present the current state-of-the-art indications for pacemaker and cardioverter-defibrillator implantations, that have widely broadened over years, the types of pacemakers, their clasification and internationally recognized coding as well as some of possible complications after implantation.
Methods and results: The first permanent pacemaker implantation in Slovenia was performed by cardiac surgeon M. Košak, cardiologist A. Jagodic and colleagues on April 16th 1965 in Ljubljana. The recipient suffered from complete atrioventricular block that clinically presented with numerous syncopes. Retrospective analysis included all the patients with re/ implanted pacemaker or cardioverter-defibrillator and accompanying electrodes. Patients’ characteristics, indications and types of the devices implanted were compared in the two representative periods: early period from 1965 –74 and recent data collected from 2001 till 2005. In Slovenia, there are 450 pacemakers and 50 cardioverter-defibrillators per million annualy performed in Maribor General Hospital and Medical Centre Ljubljana.
Conclusions: The current state-of-the-art and the most recent technological advances in the field of electrostimulation of the heart, cardioversion and defibrillation enables us to better detect and cure various cardiac rhythm disturbancies including bradycardia, tachycardia and fibrillatig episodes as well as help recognizing acute allograft rejection episodes after heart transplantations. The procedures have become simple imposing lesser and lesser burden to the patients. Taking into account all the revised and ever broadening indications, recent implantation technique implementations, optimising the choice of a pacemaker device, best suited to the patient and the initial arrhythmia and securing follow-up that enables continuous improvements and reprogramming of pacing modes, the number of pacing/defibrillating devices constantly increases. The complication rate has decreased over years and is within reasonable limits nowadays. The electrostimulation of the heart has become one of the most significant achievements of modern medicine. It is widely applied, based on scientific data, however, it is largely dependent on the actual state of the public health system and its financial resources.
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