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Full analysis of the incidence ofsudden unexplained death shows it to be no more common when fixed rate pacemakers compete with inherent beats than in the absence of competition.In I3 years (i960/I972), 77I patients have been paced on a long-term basis at St. George's Hospital, all but 27 for complete atrioventricular block. Since I962 our standard method has been with an implanted pacemaker and a transvenous endocardial electrode. This paper reports the survival rate of patients with complete block paced by this method and the causes of the deaths.Of the total series, 649 were paced by an implant with a transvenous endocardial electrode. Some of these also underwent a period of pacing with myocardial electrodes placed on the heart at operation and some were paced for periods with an endocardial electrode with the lead brought through the skin to an external pacemaker. Such patients are included in the survival statistics but only the deaths occurring while pacing with an implant and transvenous electrode are analysed here. The series included 375 men and 274 women. The age distribution is shown on the histogram (Fig. i). Of the pacemakers used in this series, 93 per cent were manufactured by Devices Ltd. The remainder covers a wide variety ofpacemakers made in the U.S.A., Sweden, Holland, and West Germany. Survival comparisonsThe survival curve is seen in Fig. 2, which also indicates the survival of 113 unpaced patients with complete atrioventricular block, and the expectation of life of the population of England and Wales matched with the paced series for age and sex (latest available figures I96I). Our series of II3 Received I3 May 1974. unpaced patients was collected before artificial pacing was introduced and in the early days of pacing (I960 to I965) when pacing was relatively unreliable. These unpaced patients include all patients with complete block seen in the department over this period and their mean age and sex distribution does not differ grossly from the paced series. They must, however, be considered as a selected

An analysis of the complications of implanting pacemakers at St George's Hospital between 1967 and 1973 highlights the difficulties of implanting foreign bodies. During this 7 years 1543 pacemakers were implanted in 779 adults. In 91 patients there were 118 implants with surgical complications, most of them due to a pressure necrosis or local infection; 3 septicaemias occurred. The various complications are classified and related to technique of implantation. Methods of management of the complications are presented. As an Appendix the operative techniques of first and subsequent implantations are outlined.

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