Nolan designed and created the first blocking oscillator and transistor-powered pacemaker. Hyman himself referred to his invention as an "artificial pacemaker", the term continuing in use to this day. [18][19], Biventricular pacing alone is referred to as CRT-P (for pacing). It is usually made of titanium, which is inert in the body. Baseline data include clinical, echocardiographic and device parameters as well as acute adverse events after ICD implantation. ", "Update on Cardiovascular Implantable Electronic Device Infections and Their Management", "Heart devices can be turned off near end of life", "Researchers Develop Personal Firewall Solution for Pacemakers, Insulin Pumps", "Pacemaker Mediated Tachycardia – an overview | ScienceDirect Topics", "Is Mode Switching Beneficial? The free end of a pacemaker lead is actually implanted into the heart muscle with a miniature screw or anchored with small plastic hooks called tines. Berlin, Boston: De Gruyter, 2019. https://doi . The risk of EMI-induced events is highest within the hospital environment. This is known as fast-pacing, overdrive pacing, or anti-tachycardia pacing (ATP). Because of population aging, however, there is a growing need for more information about the effectiveness and safety of ICD therapy in the elderly, especially in octogenarians. [47] This is becoming exceedingly rare as newer devices are often programmed to recognize supraventricular tachycardias and switch to non-tracking modes.[48]. During in-office follow-up, diagnostic tests may include: A patient's lifestyle is usually not modified to any great degree after the insertion of a pacemaker. Advances in transitional tissue welding would support this and other artificial organ/joint/tissue replacement efforts. Always keep it with you in case of accident so emergency personnel can treat you appropriately. This became the method of choice by the mid-1960s. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. However, the placement may vary on a case-by-case basis. These modes AAIR and VDD are unusual in the US but widely used in Latin America and Europe. Der Zertifizierungsprozess beginnt mit der Antragstellung an den Vorsitzenden der Kommission für Nachwuchsförderung sowie Weiter- und Fortbildung der DGTHG, gefolgt . Moreover, we cannot provide data about the cause of death because this information was not collected as part of the ICD registry. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. [Article in German] Authors Dorothee Meyer Zu Vilsendorf , Bert Hansky, Philipp Baumann . However, a patient who has several pacemaker replacements over a decade or two in which the leads were reused may require lead replacement surgery. [45], A possible complication of dual-chamber artificial pacemakers is 'pacemaker-mediated tachycardia' (PMT), a form of reentrant tachycardia. sharing sensitive information, make sure you’re on a federal Patients aged > 70 years had a similar mortality rate as octogenarians; thus, co-morbidities should be taken into account when selecting patients aged > 70 years for ICD therapy. [67], The development of the silicon transistor and its first commercial availability in 1956 was the pivotal event that led to the rapid development of practical cardiac pacemaking.[68]. The world's first implantable pacemaker patient, Arne Larsson, went on to receive 26 different pacemakers during his lifetime. Therefore, one must be cautious when evaluating elderly patients for ICD implantation and a screening for comorbidities that are limiting life expectancy to less than 1 year should be made by a multidisciplinary team approach. Development of this type of device was continuing. This pocket is usually created just above the pectoralis major muscle (prepectoral), but in some cases the device may be inserted beneath the muscle (submuscular). Novel implantable cardioverter defibrillator programming with high-rate cutoff, long detection intervals and multiple anti-tachycardia pacing reduces mortality. There was also no significant difference in the drug therapy for heart failure, which otherwise might have affected outcome. A 2008 US study found[35] that the magnetic field created by some headphones used with portable music players or cellphones may cause interference if placed very close to some pacemakers. However, larger prospective randomized controlled trials are warranted to test the benefit of ICD therapy for secondary prevention in patients aged ≥ 80 years. [46] Treatment of PMT typically involves reprogramming the pacemaker. These devices are often used in the treatment of patients at risk from sudden cardiac death. The DAVID trials[24] have shown that unnecessary pacing of the right ventricle can exacerbate heart failure and increases the incidence of atrial fibrillation. According to a recent German pacemaker registry report 12.3% of all ICD implantations were performed in octogenarians [5]. The indication for ICD implantation was ventricular fibrillation (VF) in 42.2% and ventricular tachycardia (VT) in 56.3% of patients. Connolly SJ, Hallstrom AP, Cappato R, et al. An artificial cardiac pacemaker (artificial pacemaker, and sometimes just pacemaker, although the term is also used to refer to the body's natural cardiac pacemaker) is a medical device, nowadays always implanted, that generates electrical pulses delivered by electrodes to the chambers of the heart, either the upper atria or lower ventricles.Each pulse causes the targeted chambers to contract . [42] In response to this threat, Purdue University and Princeton University researchers have developed a prototype firewall device, called MedMon, which is designed to protect wireless medical devices such as pacemakers and insulin pumps from attackers. The transvenous, or pervenous, procedure involved incision of a vein into which was inserted the catheter electrode lead under fluoroscopic guidance, until it was lodged within the trabeculae of the right ventricle. During each visit a device interrogation was performed by one of our physicians. [57][58], In 1932, American physiologist Albert Hyman, with the help of his brother, described an electro-mechanical instrument of his own, powered by a spring-wound hand-cranked motor. It is used to continuously monitor and help regulate potentially fast and life-threatening electrical problems with the heart. A further impediment to the reliability of the early devices was the diffusion of water vapor from body fluids through the epoxy resin encapsulation, affecting the electronic circuitry. By 1966, 56 patients had undergone implantation with one surviving for over .mw-parser-output .frac{white-space:nowrap}.mw-parser-output .frac .num,.mw-parser-output .frac .den{font-size:80%;line-height:0;vertical-align:super}.mw-parser-output .frac .den{vertical-align:sub}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);clip-path:polygon(0px 0px,0px 0px,0px 0px);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}5+1⁄2 years.[82][83]. Results of univariate and multivariate Cox regression model, LVEF left ventricular ejection fraction, CRT cardiac resynchronization therapy, IHD ischemic heart disease, DCM dilated cardiomyopathy, CKD chronic kidney disease. The first patient lived for a further 18 months. [6], Percussive pacing, also known as transthoracic mechanical pacing, is the use of the closed fist, usually on the left lower edge of the sternum over the right ventricle in the vena cava, striking from a distance of 20 – 30 cm to induce a ventricular beat (the British Journal of Anaesthesia suggests this must be done to raise the ventricular pressure to 10–15 mmHg to induce electrical activity). A biventricular pacemaker is an implantable device for people with advanced heart failure due to abnormal heart rhythms ( arrhythmias) and/or function. The preceding implantable devices all suffered from the unreliability and short lifetime of the available primary cell technology, mainly the mercury battery. 26.5% of octogenarians received appropriate ICD therapy (annual rate 5.3%). Some medical procedures, particularly magnetic resonance imaging (MRI), involve very strong magnetic fields or other conditions that may damage pacemakers. The more complex forms include the ability to sense and/or stimulate both the atrial and ventricular chambers. Implantable Cardioverter Defibrillator (ICD) ICDs are useful in preventing sudden death in people who have a high risk of a life-threatening arrhythmia. This single-center registry study showed that age at the time of ICD implantation is an independent risk factor for all-cause mortality in patients with ventricular arrhythmia who receive ICD therapy for secondary prevention. A second device was then implanted which lasted for two days. After satisfactory lodgement of the electrode is confirmed, the opposite end of the electrode lead is connected to the pacemaker generator. HBP in some cases can also correct bundle branch block patterns. The first implant took place in March 1960, with two further implants the following month. An ICD continuously monitors the heartbeat and delivers electric shocks, when needed, to restore a regular heart rhythm. durch Herzklappentransplantat Entzündung durch Herzschrittmacher Entzündung I49.- Sonstige kardiale Arrhythmien Herzschrittmacher I49.9 Kardiale Arrhythmie, nicht näher bezeichnet Z45.- Threshold duration: The time that the device requires at the preset amplitude to reliably pace the atrium or ventricle connected to the lead. There are a few activities that are unwise, such as full-contact sports and exposure of the pacemaker to intense magnetic fields. This transistorized pacemaker, housed in a small plastic box, had controls to permit adjustment of pacing heart rate and output voltage and was connected to electrode leads which passed through the skin of the patient to terminate in electrodes attached to the surface of the myocardium of the heart. Many of these have been made possible by the transition to microprocessor controlled pacemakers. 8600 Rockville Pike Estimated battery life at current rate: As modern pacemakers are "on-demand" and only pace when necessary, battery lifespan is affected by how much the pacemaker is utilized. Others send out a fixed rate of impulses. Pacemakers that control both the atria and ventricles are called dual-chamber pacemakers. No age-related difference could be seen for appropriate ICD therapy, proving the effectiveness of ICD therapy in treating ventricular arrhythmias in the elderly, which was comparable to other studies [7]. It is an emergency procedure that acts as a bridge until transvenous pacing or other therapies can be applied. 2018 Nov;143(22):1608-1616. doi: 10.1055/a-0560-3180. Implant position, patient characteristics and device factors, such as shock impedance, can influence defibrillation success. A patient in many jurisdictions (including the US) is deemed to have a right to refuse or discontinue treatment, including a pacemaker that keeps them alive. Rate of appropriate ICD therapy after ICD implantation in the age group < 80 years and ≥ 80 years. Antiarrhythmics vs Implantable Defibrillator study. In 1889, John Alexander MacWilliam reported in the British Medical Journal (BMJ) of his experiments in which application of an electrical impulse to the human heart in asystole caused a ventricular contraction and that a heart rhythm of 60–70 beats per minute could be evoked by impulses applied at spacings equal to 60–70/minute. Rate responsive pacing allows the device to sense the physical activity of the patient and respond appropriately by increasing or decreasing the base pacing rate via rate response algorithms. The lead removal technique will vary depending on the surgeon's estimation of the probability that simple traction will suffice to more complex procedures. Survival after implantable cardioverter-defibrillator implantation in the elderly. The authors declare that they have no conflict of interest. This pacemaker was worn on a belt and powered by a rechargeable sealed battery, enabling users to live a more-normal life. McDonagh T, Metra M, Adamo M, et al. The procedure is performed by incision of a suitable vein into which the electrode lead is inserted and passed along the vein, through the valve of the heart, until positioned in the chamber. Most pacemakers are on demand, in which the stimulation of the heart is based on the dynamic demand of the circulatory system. [59][60], An apparent hiatus in the publication of research conducted between the early 1930s and World War II may be attributed to the public perception of interfering with nature by "reviving the dead". Sensing: the ability of the device to "see" intrinsic cardiac activity (atrial and ventricular depolarization). Acute adverse events leading to surgical intervention were low (n = 13) and not age-related. Therefore, no special precautions are needed when household appliances are used. Skip to content. [74], In 1959, temporary transvenous pacing was first demonstrated by Seymour Furman and John Schwedel, whereby the catheter electrode was inserted via the patient's basilic vein.[75]. Jährlich werden mehr als 500 Herzschrittmacher und mehr als 300 Defibrillatoren eingesetzt. In addition, according to the American Heart Association, some home devices have the potential to occasionally inhibit a single beat. Mortality rates did not differ significantly between octogenarians and other elderly aged 70–79 years. Sometimes devices resembling pacemakers, called implantable cardioverter-defibrillators (ICDs) are implanted. Huang DT, Sesselberg HW, McNitt S, MADIT-II Research Group et al. As of 2014[update] the five most commonly used cardiac pacing device manufacturers (covering more than 99% of the US market) made FDA-approved MR-conditional pacemakers. A meta-analysis of three large secondary prevention trials comparing ICD to Amiodarone (AVID [3], CASH [2] and CIDS trial [1]) did not yield any significant benefit of ICD therapy over Amiodarone regarding all-cause mortality and absence of arrhythmic death in patients aged ≥ 75 years [6]. [25], The batteries within a pacemaker generator typically last 5 to 10 years. Careers, Unable to load your collection due to an error. and transmitted securely. Our study included a real-life cohort; therefore, it is possible that older patients, especially octogenarians, who were eligible for ICD therapy were more carefully selected with regard to concomitant diseases and their general health status than younger patients. Download a printable Implantable Cardioverter Defibrillator (ICD) Wallet ID card (PDF). Patients were divided into 6 groups according to their age at the time of ICD implantation [≤ 59 years (n = 202), 60–64 years (n = 75), 65–69 years (n = 81), 70–74 years (n = 70), 75–79 years (n = 57) and ≥ 80 years (n = 34)]. A pacemaker may be implanted whilst a person is awake using local anesthetic to numb the skin with or without sedation, or asleep using a general anesthetic. Other factors affecting battery life include programmed output and algorithms (features) that use battery power. The mortality rate of patients aged ≥ 80 years was significantly higher than that of patients aged ≤ 69 years (p < 0.001), but similar to that of patients aged 70–79 years. If elderly patients are eligible for a CRT, it is important to discuss whether one should implant a CRT-P or a CRT-D. Because the trials, which have investigated this topic, have included only patients with a primary prevention indication [8, 11], no scientific data exist for CRT-P for patients with a secondary prevention indication. The Nanostim pacemaker received European CE marking in 2013. Baseline characteristics (compared age < 80 years and ≥ 80 years; p value ≤ 0.05 considered statistically significant), BMI body mass index, LVEF left ventricular ejection fraction, ICD implantable cardioverter-defibrillator, VF ventricular fibrillation, VT ventricular tachycardia, S-ICD subcutaneous implantable cardioverter-defibrillator, CRT cardiac resynchronization therapy, IHD ischemic heart disease, DCM dilated cardiomyopathy, MI myocardial infarction, AFib atrial fibrillation, PAD peripheral artery disease, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, ICD indication othersa: patients with an out of hospital cardiac arrest (OHCA) and high probability of a primary rhythmogenic cause though first documented rhythm was asystole, pulseless electrical activity (PEA) or sinus rhythm, Othersb: primary VF: 31 (6.0%), myocarditis: 13 (2.5%), hypertrophic (obstructive) cardiomyopathy (H(O)CM): 11 (2.1%), secondary cardiomyopathy: 12 (2.3%), long-QT-syndrome: 10 (1.9%), arrhythmogenic right ventricular dysplasia (ARVD): 6 (1.2%), Tako Tsubo cardiomyopathy: 6 (1.2%), Brugada syndrome: 3 (0.6%), non-compaction cardiomyopathy: 2 (0.4%), short-QT-syndrome: 1 (0.2%). [23], Dynamic pacemaking technology could also be applied to future artificial hearts. Often, for patients in normal sinus rhythm, there is also a lead in the right atrium to facilitate synchrony with the atrial contraction. The spike of an "atrial-demand pacemaker" appears just before the P wave. He died in 2001, at the age of 86, outliving the inventor and the surgeon. Some movements of the shoulder within a few weeks of insertion carry a risk of dislodging the pacemaker leads. The first follow-up visit took place 6 weeks after the implantation. Data were obtained from a local ICD registry. Survival rate of patients with an age ≥ 80 years compared to patients with an age < 80 years, Mortality after ICD implantation (compared to ≥ 80 years; p ≤ 0.05 considered statistically significant). [38], A panel of the Heart Rhythm Society, a US specialist organization based in Washington, DC, deemed that it was legal and ethical to honor requests by patients, or by those with legal authority to make decisions for patients, to deactivate implanted cardiac devices. Language links are at the top of the page across from the title. [7], Transcutaneous pacing (TCP), also called external pacing, is recommended for the initial stabilization of hemodynamically significant bradycardias of all types. The number of device-related adverse events requiring surgical intervention was low across all age groups, so that the implantation procedure itself does not seem to involve any increased risk in elderly patients. Severe comorbidities such as renal failure or other systemic diseases may result in ventricular arrhythmias due to hormonal and electrolyte changes, which, in turn can result in higher mortality. [88] The European study was stopped after reports of six perforations that led to two patient deaths. 57.3% of patients had ischemic heart disease, and mean LVEF was 38 ± 14%. The team was headed by Roger Nolan, an engineer with the Lucas Group Research Centre. It has been associated with increased risk of atrial fibrillation, heart failure, weakening of the heart muscle and potentially shorter life expectancy. In the late 1960s, several companies, including ARCO in the US, developed isotope-powered pacemakers, but this development was overtaken by the development in 1971 of the lithium iodide cell by Wilson Greatbatch. A "ventricular triggered pacemaker" produces the impulse just after a pulse is created in the ventricular tissue and it appears as a simultaneous spike with QRS. Should you have . The device parameters, any episodes of VA, ICD therapies and device-related complications were documented in the registry. The rescuer selects the pacing rate, and gradually increases the pacing current (measured in mA) until electrical capture (characterized by a wide QRS complex with a tall, broad T wave on the ECG) is achieved, with a corresponding pulse. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. there are specific problems for antibradycardia and resynchronizing pacemakers as well as implantable . Gesundheitswesen, Fachgruppe Herzschrittmacher und DefibrillatorenbeimIQTIG–Institut für Qualitätsicherung und Transparenzim (2017) Jahresbericht 2017 des Deutschen Herzschrittmacher-und Defibrillatorregister—Teil 2 Implantierbare Cardioverter-Defibrillatoren (ICD). This pacemaker, the first implanted in the Americas, lasted until the patient died of other ailments, nine months later. In our study the use of a single-lead ICD was rather high (63%), while CRT devices were implanted in only 6.2% of our patients. [62] The device was first tested on a dog at the University of Toronto's Banting Institute. Patients with serious comorbidities, who are unlikely to survive more than 1 year, should not receive an ICD therapy [12]. Leadless pacemakers are devices that are small enough to allow the generator to be placed within the heart, therefore avoiding the need for pacing leads. The different age groups did not significantly differ with regard to safety in the first month after ICD implantation. Cardiac Arrest Study Hamburg . The procedure is performed by placing two pacing pads on the patient's chest, either in the anterior/lateral position or the anterior/posterior position. Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias. [29] The first to be so specified was the Medtronic Revo MRI SureScan, approved by the US FDA in February 2011,[30] which was the first to be specified as MR conditional. Furthermore, a Cox-Regression model was used to analyze the influence of age, left ventricular ejection fraction (LVEF), cardiac resynchronization therapy (CRT), ischemic heart disease (IHD), dilated cardiomyopathy (DCM), chronic kidney disease, diabetes mellitus and obesity on all-cause mortality after ICD implantation. If it does sense electrical activity, it will hold off stimulating. Having a pacemaker does not imply that a patient requires the use of antibiotics to be administered before procedures such as dental work. Unauthorized third parties may be able to read patient records contained in the pacemaker, or reprogram the devices, as has been demonstrated by a team of researchers. [39][40] Some patients consider that hopeless, debilitating conditions, such as severe strokes or late-stage dementia, can cause so much suffering that they would prefer not to prolong their lives with supportive measures. When the pacemaker wire or "lead" does not detect heart electrical activity in the chamber – atrium or ventricle – within a normal beat-to-beat time period – most commonly one second – it will stimulate either the atrium or the ventricle with a short low voltage pulse. [61] For example, "Hyman did not publish data on the use of his pacemaker in humans because of adverse publicity, both among his fellow physicians, and due to newspaper reporting at the time. This is the American ICD-10-CM version of Z95.810 - other international versions of ICD-10 Z95.810 may differ. Finally, this study was a single-center study; thus, we do not know if our results can be generalized for other medical centers, which may have other strategies for selecting patients eligible for ICD therapy or may use other ICD programming to treat ventricular arrhythmias. The large scale of clinical baseline characteristics in our registry enables the identification of confounders that may influence the outcome after ICD implantation in elderly patients. [4], A specific type of pacemaker called an implantable cardioverter-defibrillator combines pacemaker and defibrillator functions in a single implantable device. The data of all patients, who received an ICD at our department, were entered into a database. For selected patients at risk of arrhythmias, CRT can be combined with an implantable cardioverter-defibrillator (ICD): such devices, known as CRT-D (for defibrillation), also provide effective protection against life-threatening arrhythmias. In the UK in the 1960s, Lucas Engineering in Birmingham was asked by Mr Abrams of The Queen Elizabeth Hospital to produce a prototype for a transistorised replacement for the electro-mechanical product. 9/1 Herzschrittmacher-Implantation (HSMDEF . [42] The demonstration worked at short range; they did not attempt to develop a long range antenna. For example, ICD deactivation in patients with a terminal illness may be ethically permissible to avoid painful ICD shocks [13]. In a population-based registry study in Ontario, Canada, the outcome of ICD therapy for secondary prevention was compared between 159 patients aged ≥ 80 years and patients of other age groups. It appears as a discharge following the p wave but prior to the QRS which is commonly widened.[17]. A sub-study of the MADIT-II trial [9] with 204 patients aged ≥ 75 years who had received an ICD for primary prevention showed a non-significant reduction in mortality. This retrospective study compared the outcome after ICD implantation between octogenarians and other age groups. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Kontakt. Lead replacement may be done in one of two ways. Die Implantation und Nachsorge von Herzschrittmachern und Defibrillatoren (ICD) ist integraler Bestandteil der Patientenversorgung im HDZ NRW. There was no age-related difference in appropriately treated ventricular arrhythmias by ICD therapy. Informed consent signed by all participants. [49] Changes to the programming of the pacemaker may overcome lead degradation to some extent. eines implantierten Herzschrittmachers Fehllage eines elektronischen. The most common reason for lead removal is infection; however, over time, leads can degrade due to a number of reasons such as lead flexing. Once the pacemaker is implanted, it is periodically checked to ensure the device is operational and performing appropriately; the device can be checked as often as is deemed necessary. | DFW", "Laser-assisted extraction of pacemaker and defibrillator leads: the role of the cardiac surgeon", "An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker", "Long-term survival after pacemaker implantation Prognostic importance of gender and baseline patient characteristics", "Electrical stimulation of the heart in man", "IEEE Milestone in Electrical Engineering and Computing", "Gunning, Alfred James – Biographical entry – Plarr's Lives of the Fellows Online", "Treatment of chronic heart block with the Lucas induction coil pacemaker", "Arne H. W. Larsson, 86; Had First Internal Pacemaker", "The History of Nuclear Powered Pacemakers", "Pioneers of the Medical Device Industry", "Medtronic's Minimally Invasive Pacemaker the Size of a Multivitamin", "European Post-Approval Trial for Nanostim", "New Data on Leadless Pacemaker Supports Efficacy, Safety", "British charity calls for re-use of pacemakers abroad", "Reuse of cardiac implantable electronic devices to improve and extend lives: a call to action", "LivaNova closes $190 CRM sale to MicroPort", Detecting and Distinguishing Cardiac Pacing Artifacts, Implantable Cardioverter Defibrillator from National Heart, Lung and Blood Institute, Current indications for CRT-P and CRT-D: Webinar from the European Heart Rhythm Association (EHRA), Cardiology diagnostic tests and procedures, Percutaneous pulmonary valve implantation, Cardiac resynchronization therapy device implantation, https://en.wikipedia.org/w/index.php?title=Artificial_cardiac_pacemaker&oldid=1158570196, Articles with incomplete citations from October 2020, Short description is different from Wikidata, Pages using infobox medical intervention with unknown parameters, Articles with unsourced statements from April 2013, Articles containing potentially dated statements from 2014, All articles containing potentially dated statements, Articles containing potentially dated statements from 2010, Articles containing potentially dated statements from 2016, Creative Commons Attribution-ShareAlike License 3.0, ICD with bradycardia pacing as well as shock, ICD with tachycardia (and bradycardia) pacing as well as shock. None of the patients in the entire study group had developed lead perforation, pneumothorax, or pericardial effusion (Table (Table44). In 1958, engineer Earl Bakken of Minneapolis, Minnesota, produced the first wearable external pacemaker for a patient of C. Walton Lillehei. Z95.810 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. One of the earliest patients to receive this Lucas pacemaker device was a woman in her early 30s. Patients aged ≥ 80 years had more often ischemic heart disease, permanent atrial fibrillation and chronic kidney disease as well as a lower body mass index. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough, or because there is a block in the heart's electrical conduction system. [11] As pacemaker leads can fail over time, a pacing system that avoids these components offers theoretical advantages. Improved survival associated with prophylactic implantable defibrillators in elderly patients with prior myocardial infarction and depressed ventricular function: a MADIT-II substudy. Routine pacemaker checks are typically done in-office every six months, though will vary depending upon patient/device status and remote monitoring availability. D. Randolph Jones was the EP doctor. Our single-center registry study showed a high mortality rate in octogenarians with ICD therapy for secondary prevention.