DefinePK

Abstract

To the Editor,
We read with great interest the article titled “Pioneering Efforts: Cardiac Device Implantation Trends and Variable Patient Outcomes – A Community Benefit Tool” by Ghulam Kubra et al.[1] We commend the authors for highlighting the trends in cardiac device implantation in Pakistan, particularly the effective use of dual-chamber pacemakers and single-chamber ICDs, with complete heart block as the main indication. The reported low mortality rates indeed reflect the value of free cardiac care services.
While the study is insightful, we would like to highlight a few areas for potential enhancement. First, although device performance metrics such as sensing and impedance are reported, the study does not explore lead stability or early device function. These parameters are important for assessing long-term safety and clinical performance. A 2025 study demonstrated that analyzing lead impedance, capture threshold, and sensing amplitude is crucial for early detection of device-related issues [2].
Second, the study does not address patient-reported outcomes such as quality of life or emotional well-being post-implantation. Szwamel et al. emphasized the importance of including psychological parameters when evaluating cardiac outcomes, especially after valve implantation [3].
Third, outcome data were not stratified by age or gender, which may mask important demographic differences. Dalton et al. have shown that risk is often underestimated in older adults, potentially impacting treatment decisions [4].
Lastly, the study lacks details about device longevity, generator replacement, and battery depletion timelines. In contrast, Lüker et al. offered a comprehensive evaluation of battery performance and generator replacement reasons, providing insights essential for long-term planning [5].
Incorporating these elements in future studies will enrich clinical insights and support better patient-centered care in cardiac device therapy.
AUTHORS' CONTRIBUTION
WA, KZ, HK, and JS: Concept and design, data acquisition, interpretation, drafting, final approval, and agree to be accountable for all aspects of the work.
Acknowledgment: None.
Funding: No specific grant for this research from any public, commercial, or not-for-profit funding agency
References

Kubra G, Nadeem D, Sikandari F, Qayoom R, Ansari MS, Irfan G. Pioneering Efforts: Cardiac Device Implantation Trends and Variable Patient Outcomes – A Community Benefit Tool. Pak Heart J. 2024;57(04):297-303. DOI: 10.47144/phj.v57i4.2837
Neupane S, Goswami T. Pacemaker In-terrogation Reports: Comparing Diagnostics, Lead Impedance, Pacing Thresholds and Battery Performance. Res Intell Manuf Assem, 2025;4(1):144-67. DOI: 10.25082/RIMA.2025.01.002
Pecoraro F, Luzi D. Using unified modeling language to analyze business processes in the Delivery of Child Health Services. Int J Environ Res Public Health. 2022;19(20):13456. DOI: 10.3390/ijerph192013456
Dalton JE, Perzynski AT, Zidar DA, Gornik HL, Josephson RA, Misra S, et al. Failure of traditional risk factors to adequately predict cardiovascular events in older populations. J Am Geriatr Soc. 2020;68(4):754-60. DOI: 10.1111/jgs.16329
Lüker J, Strik M, Andrade JG, Raymond-Paquin A, Elrefai MH, Roberts PR, et al. Incidence of premature battery depletion in subcutaneous cardioverter-defibrillator patients: insights from a multicenter registry. J Interv Card Electrophysiol. 2023. DOI: 10.1007/s10840-023-01468-1