Decision Analysis for Choosing the Hemodynamically Optimum Pacemaker

The current and future generation of pacemakers present a bewildering array of options for the implanting physician. The current economical and legal climate makes it imperative that the appropriate pacemaker is chosen. We developed an algorithm based on our experiences and published data for choosing the optimum pacing mode. This algorithm was programmed into a commercially available expert system shell on a PC platform. Determination was made through a question‐and‐answer session, with the system prompting the physician with questions and appropriate answer choices. Program output included “Recommended”, “Possible But Not Optimal”, and “Not Recommended” pacemakers. Only the general category of pacer type was suggested, not any particular manufacturer. Explanations and reasonings are also displayed during the consultation for educational purposes. The system was then tested retrospectively on 30 consecutive pacemaker implantations. The number of times that the computer recommendation and pacer received agreed was 27. The number of times that the computer recommended a pacer type, but the patient received a different one was 3. The computer did not recommend incorrectly in any instance. There were three different implants: 1 patient was unable to receive suggested pacer for technical reasons; 2 patients had physicians that did not have programmers for the appropriate pacemaker. Based upon this retrospective analysis we conclude that a decision algorithm can be accurately applied to choose the appropriate pacemaker for implantations.