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Objective:To investigate what factors affect reconstruction timing of pacing system, and to explore how optimize reconstruction timing of pacing system. To provide a new scientific basis administer domestic Pacemaker patients.Methods:Through Continuous collect the pacemaker reimplantation patients of the First Affiliated Hospital of Kunming Medical College from January 1992 to October 2010 with a total of 473 cases, involving 332 patients. All patients accept a long time follow-up, including basic information, the causes and time of the first pacemaker implantation and pacemaker reimplantation, pacemaker parameters, surgical treatment measures and related program data. All these data were recorded in detail, making use of statistical methods to do a systematic review.Result:(1)The reason of pacemaker replacement as follow:normal battery depletion, accounting for 64.3%; accelerated battery depletion, accounting for 12.3%; for the disease need to upgrade the original pacing system, accounting for 10.8%; electrodes dislocation, accounting for 4.4%; electrodes fracture or insulation layer breakage, accounting for 3.6%; pacing system infection, accounting for 3.4%(2)In the planned reconstruction of pacing system group(287 cases,60.7%), normal battery depletion was the first reason; in the earlier than planned reconstruction of pacing system group(130 cases,27.5%), complications and some patients themselves factors were the most important reason; in the later than reconstruction of pacing system group(56 cases,11.8%), poor economic conditions was the first reason (3)Among Three different reconstruction timing groups,299cases(63.2%) had a reasonable timing for pacing system reconstruction; 174 cases(36.8%) had a unreasonable timing for pacing system reconstruction. In the Unreasonable reconstruction timing group, due to the complications 60 cases, absence of attention were 37 cases, poor economic conditions were 29 cases,26 cases were because traffic inconvenience,13 cases were because poor physical condition, besides, medical sources factor were 9 cases (4)The reasonable timing reconstruction group were safer than the unreasonable timing reconstruction group(P<0.01), and the cost was lower.(P＜0.01) (5)The life of pacemaker, especially DDD was significantly prolonged over 14 months than the life of pacemaker 20 years ago.Conclusion:(1)The reason of pacemaker replacement as follow: normal battery depletion, accelerated battery depletion, for the disease need to upgrade the original pacing system, electrodes dislocation and fracture, pacing system infection, screws loose (2) The reason of unreasonable reconstruction timing as follow:the complications, the patients were lack of emphasis on disease, poor economic conditions, traffic inconvenience, poor physical condition, medical source factors (doctor based only on pacemaker manufacturers warranty period or the patient will to replace the pacemaker) (3)With the pacing technology devolopment, time of reconstruction have a trend to delay (4)Avoiding unreasonable reconstruction timing, doctor must take effective measures to decide reasonable reconstruction timing, which can reduce unnecessary costs and complications caused by the unreasonable reconstruction pacing system, effectively improve the pacing system security, to extend longevity of pacing system, so that pacing system can better adapt to the diseases (5)Optimization of pacing system reconstruction timing should be take effective measures, for example, to optimize perioperative period process when the pacemaker was implanted for the first time; when pacing system reimplantation, doctor must be possibly reduce risk; to optimize pacing system follow-up process; to increase both doctors and patients knowledge about follow-up; doctor must make use of advanced hardware and software of pacing system, and new technologies of follow-up.
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