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KMID : 0368120160460050654
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Korean Circulation Journal
2016 Volume.46 No. 5 p.654 ~ p.657
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Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation
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Jang Sung-Won
Rho Robert W.
Kim Tae-Seok
Kim Sung-Hwan
Shin Woo-Seung
Kim Ji-Hoon
Oh Yong-Seog
Lee Man-Young
Zen Eiwa
Rho Tai-Ho
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Abstract
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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.
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KEYWORD
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Pacemaker, artificial, Sick sinus syndrome, Atrioventricular block, Physicians, Guidelines
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