Four-Year Experience with an Implanted Cardiac Pacemaker

Abstract

The report presents experiences with long-term electric stimulation of the heart in 77 patients during 4 years. The implanted, fixed-rate pacemaker has eliminated Stokes-Adams attacks due to ventricular standstill and has also largely prevented seizures due to ventricular tachycardia or fibrillation. In addition, the artificial pacemaker has been very valuable in improving congestive heart failure and other manifestations f diminished cardiac output in patients with heart block and slow ntricular rates. Stokes-Adams attacks, unless due to a transient or reversible conditions, are a compelling indication for implantation of a pacemaker. In view of the unpredictability and lethal potentiality of the attacks and their uncertain prevention by drugs, even a single, mild episode calls for the assured prevention of further seizures by a reliable electric pacemaker. The low operative mortality and morbidity in this series, even with elderly and desperately ill patients, indicate that there are few if any patients with Stokes-Adams disease to whom this treatment should not be offered. Congestive heart failure and other manifestations of diminished cardiac output in patients with slow ventricular rates constitute an additional indication for surgery. Heart block alone in an asmptomatic patient is not an indication for treatment.