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The long-term effect of pacemakers in the management of bradycardic heart failure with or without syncope was tested on 337 patients. The cumulative survival rate of patients with Adams-Stokes attacks without heart failure (group I) was 91% at the end of one year, 73% at the end of three and 35% at the end of eight years. Among patients with Adams-Stokes attacks and accompanying heart failure (group II) 81% survived one year, 64% three and 46% five years, but only 25% eight years. Among patients in whom heart failure was the only indication for pacemaker implantation (group III), 70% were still alive after one year, 56% after three and 17% after five years. Related to the severity of heart failure before and after pacemaker implantation, most of the patients of group II (mild or moderately severe failure) had definite improvement, while of those in group III (mainly severe failure) only about half had less cardiac failure. In patients with severe heart failure and bradycardia (without syncope) long-term results are not likely to be very good, as regards both duration of survival and physical capacity.

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