Follow-up management of the paced patient

The recommendation and subsequent implantation of a pacemaker constitutes a therapeutic prescription with the same long-term responsibility for the periodic assessment of the continued appropriateness of that therapy as with the prescription of any pharmacologic agent. The multiplicity of programmable options available in the modern pacemaker allows the physician to titrate the dose of pacing in a manner similar to the periodic adjustment of the dose of a medication. A prime example is renal failure which commonly requires a decrease in the dose of some medications necessitated by a reduction in renal clearance, this same condition may require an increase in the programmed output of the pacemaker if the patient is prone to hyperkalemia because of associated rises in the capture threshold. This chapter will review multiple aspects and techniques associated with the routine follow-up of the pacing system including biventricular systems.