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Korean Circ J. 2016 Sep;46(5):654-657. Epub 2016 Sep 28.

Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation.

Author information

1
The Catholic University of Korea, Seoul, Korea.
2
Virginia Mason Medical Center, WA, USA.
3
Gimhae Jungang Hospital, Busan, Korea.
4
Takeda Hospital, Kyoto, Japan.

Abstract

BACKGROUND AND OBJECTIVES:

The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM.

MATERIALS AND METHODS:

Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation.

RESULTS:

Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality.

CONCLUSION:

Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.

KEYWORDS:

Atrioventricular block; Guidelines; Pacemaker, artificial; Physicians; Sick sinus syndrome

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