Subjective Consequences of Permanent Pacemaker Therapy in Patients Under the Age of Retirement HANS MICKLEY,* JAN PETERSEN,** and BENT LYAGER NIELSEN** From the *Department of Clinical Physiology, and the **Department of Cardiology and Medicine B, University Hospital, Odense, Denmark MICKLEY, H.| ET AL.: Subjective Consequences of Permanent Pacemaker Therapy in Patients Under the Age of Retirement. During a 5-year period, 81 patients ages 20 to 60 years old had implantation of a permanent cardiac pacemaker at the University Hospital, Odense. At follow-up, during 1985, the 73 survivors received a semi-structured questionnaire regarding subjective consequences o/pacemaker ther- apy, and 72 people (98.6%) agreed to participate. The mean pacing period frangej was 33.8 (11-72) months. Surgical intervention was required in 14 patients (19.4%) during follow-up. Regarding aJI symp- toms 67 patients (93.1%) perceived benejit from the pacemaker. The e^ectiveness of cardiac pacing was most pronounced in subjects su^ering from syncope and/or dizziness. Eight patients (11.1%) perceived anxiety most frequently due to fear of pacing failure. Physical complaints were present in 17 patients (23.6%), and the discomfort was mainly due to the size of generator, pain/tenderness from the scar or a sensation o/"impulses"/palpitations. To the majority (49 patients or 68.1%) pacemaker treatment did not influence quality of sexual activity. Six patients (8.3%) perceived an improvement, whereas a correspond- ing number felt deterioration in sexual activity following pacemaker implantation. Pacemaker therapy had not affected life quality in 30 (41.7%) of the patients. However 31 patients (43%J/elt an improvement, and only a minority of ten patients (13.9%) perceived deterioration in quality of life owed to pacemaker therapy. (PACE, Vol. 12, March 1989) pacemaker therapy, subjective consequences, psycho-social consequences, patients under the age of re- tirement Introduction A quarter century has passed since the intro- duction of cardiac pacemakers for the treatment of patients with complete heart block and Stokes- Adams attack. We know that pacemaker therapy prolongs life in such patients. In other situations length of life after pacemaker implantation is af- fected primarily by the patients' age and the pres- ence of such conditions as congestive heart fail- ure, diabetes mellitus, stroke, and renal failure.' However, prolongation of life is not the sole index of successful treatment. Benefits such as cessation Address for reprints: Hans Mickley, Department of Clinical Physiology, University Hospital, 5000 Odense C, Denmark. Received May 22, 1987; revision January 28, 1988; revision November 14, 1988; accepted November 15, 1988. of symptoms and improved quality of life must be expected, too. Only a few studies have dealt with patients' perceptions of the effects of pacemaker treatment. Based on a questionnaire we wanted to investi- gate these aspects in a population of pacemaker patients under the age of retirement. Patients and Methods During the 5-year period, 1979 to 1984, a total of 630 people had a pacemaker implantation at the University Hospital, Odense. Eighty-one (12.9%) patients were in the occupationally active age defined as being 20 to 60 years old. The clini- cal records of the 26 women and 55 men were analyzed. The average age (range) at implantation for the population was 48.2 years (20.5 to 59.9 years); for women: 49.5 years (21.2 to 59.9 years); PACE, Vol. 12 March 1989 401