The Intern At Work: Internal Medicine 282. The Internist's Guide to Pacemakers
May 11, 2025
In this discussion, Dr. Karen Konieczny, a board certified cardiologist and electrophysiologist from St. Michael's Hospital, delves into the complexities of pacemaker implantation. She highlights the rising trends in pacemaker use among aging populations and addresses unique cases like cardiac sarcoidosis. The episode also navigates sinus node dysfunction, discusses advanced pacemaker technologies like leadless options, and underscores the importance of careful evaluation in treatment decisions, especially for elderly patients.
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Aging Population Drives Pacemaker Usage
- Permanent pacemaker implantation prevalence increases with age, especially among those 75 and older.
- In Ontario and Canada, about 25,000 pacemakers are implanted annually, mostly in large tertiary centers.
Confirm Symptom-Rhythm Correlation
- Always document symptom rhythm correlation before deciding on a pacemaker.
- Confirm symptoms like lightheadedness are due to bradycardia, not other causes.
Red Flags in Syncope History
- Lack of prodrome, recurrent syncope with injury, and syncope during exercise are red flags for arrhythmic syncope.
- These historical features increase suspicion for needing a pacemaker.