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A technique for determining the characteristics of impulses from implanted cardiac pacemakers with external methods is reviewed, and its value in detecting pacemaker failures is discussed. The resultsfrom a 2-year application with 6ii controls in clinical routine are presented. Methods and stimulating principlesThe pacemaker system consists of an impulse generator, an endocardial electrode (Elema EMT 588), and an indifferent electrode (Elema EMT 564) subcutaneously implanted below the left costal margin. The generators (fixed rate generators, Elema EM I39 and 142; atrial synchronized, Elema EM 141; and QRS synchronized, Elema EM 143) are implanted subcutaneously in the abdomen. At the control performed every third to fourth month, and otherwise when symptoms indicate, the history and electrocardiogram are taken, a physical examination is performed, and an impulse recording undertaken.The impulse frequency was calculated from the electrocardiogram (Elema-Schonander Mingograf 42). The generator impulses detected from electrodes on the left arm and leg (lead III) were displayed on an oscilloscope (Tektronix 502 A). The horizontal sweep was triggered by the pacemaker impulses. The amplification was usually 50 millivolts per centimetre on the vertical axis, and the speed of the sweep o 5 msec.lcm. A photograph of the oscilloscope display has been taken at every check-up, and the peak amplitude and duration of the impulse have been measured.

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