The Regionalization of High‐Volume Cardiac Pacing: A Prospective Cohort Study on Safety, Feasibility, and the Learning Curve in a Geriatric Population

BACKGROUND: Centralizing pacemaker implantations delays care for geriatric populations in remote regions, particularly in post-Soviet healthcare systems like Latvia. We hypothesized that a regional hospital could safely establish a high-volume pacing program to overcome geographical barriers, utilizing structured mentorship from a national tertiary center. METHODS: This 2-year prospective observational study evaluated 173 consecutive patients (mean age 78.1 years) undergoing permanent pacemaker implantation at Daugavpils Regional Hospital. Procedures were performed by two regional interventional cardiologists transitioning to independent practice, supported by Latvian Cardiology Centre mentors. Endpoints included 30-day major complications, procedural efficiency, surgical learning curve evaluation using Cumulative Sum (CUSUM) analysis, and patient-reported quality of life (AQUAREL, SF-36). RESULTS: Across 173 procedures (66.5% dual-chamber, 33.5% single-chamber), the overall complication rate was 5.7%. CUSUM analysis demonstrated a complication rate reduction from 8.7% during the initial acquisition phase to a 3.4% expertise plateau. Procedural efficiency stabilized with a mean fluoroscopy time of 3.9 min. Specific complications included lead dislodgement (2.3%), pocket hematoma (1.7%), pneumothorax (1.1%), and wound infection (0.6%), managed successfully without mortality or device abandonment. At 6-month follow-up, patients reported significant quality of life improvements and high trust in the regional team. CONCLUSIONS: Regional high-volume cardiac pacing programs are safe and vital for equitable geriatric care. With structured mentorship, regional hospitals can overcome historical centralization, safely transitioning to independent high-volume centers and achieving an expert-level safety profile non-inferior to tertiary standards.