Patients with High‐Grade Atrioventricular Block Treated and not Treated with a Pacemaker

Abstract

Patients [188] with chronic and with intermittent high-grade atrioventricular block (AVB) were studied retrospectively. Patients [71] were treated with fixed-rate and 51 with demand-type pacemaker, 59 were treated conservatively. Observation time was 3 yr minimum and 14.5 yr maximum. The mean age was about 7 yr higher, and 8.7% more patients had chronic AVB in the conservatively treated than in the pacemaker-treated group. About 12% more patients had Adams-Stokes attacks in the pacemaker group than in the conservatively treated group. There were 7% more patients with coronary heart disease (CHD) in the pacemaker group, and 10% more with aortic valve disease among the conservatively treated. Totally, 4.4% of the patients had a calcification of the mitral annulus fibrosus. The 2 groups were comparable in functional class and heart size. Survival showed 31% more sudden deaths in the conservatively treated than in the pacemaker group. Sudden deaths were not more frequent amoug the patients with CHD than in those without. Long-term survival showed the more favorable result for the patients with than without pacemaker treatment. There were 8 (11.3%) unexplained sudden deaths among the patients treated with fixed-rate pacemaker, only 3 (5.9%) among those treated with a demand unit. The fixed-rate and the demand units showed a mean longevity of 37.2 and 34.6 mo., respectively.