Ten-year survey of treatment with implanted cardiac pacemaker.

Abstract

Since the first implant of an artificial cardiac pacemaker in a patient by Senning in 1958 the reliability of apparatus has increased considerably and the indications for long-term pacing have greatly extended. In this paper Aetiology Thirty-two patients (8-6%) had associated ischaemic heart disease as judged by cardiac infarction, angina, or E.C.G. evidence before the onset of heart block though this was not proved to be the cause of the block. Thirty patients (8%) probably had high block in the atrioventricular node, diagnosed on the basis of a narrow QRS complex, a rapid ventricular rate which increased with effort, and a normal sized heart on x-ray examination. It is impossible to determine how many of these had congenital block because the age at presentation varied from 12-52 years. There were 24 patients (6-5%) in whom the block was attributed to miscellaneous causes such as calcific aortic stenosis, myocarditis, Chagas's disease, Reiter's syndrome, or cardiomyopathy. The remaining 77% were diagnosed as having degenerative fibrosis of the conducting system. These aetiological factors applied about equally to both sexes except that 23 of the 32 patients with ischaemic heart disease were male.Indications for Pacing Pacemakers were implanted because of syncopal episodes in 290 patients (78%) and because of dizzyness or near-syncope in a further 30 (8%). Thus 86% were paced for a Stokes-Adams attack, either major or minor. Twenty-four patients were paced because of heart failure and bradycardia without syncope, three because complete heart block persisted one month after cardiac infarction, and two because they needed long-term pacing after cardiac surgery.Twenty patients were paced because of intermittent episodes of supraventricular tachycardia (flutter, fibrillation, paroxysmal atrial tachycardia, etc.) alternating with severe bradycardia. Various supraventricular natural pacemakers arose and junctional rhythms were common. Other patients who were paced for tachycardia alone are being reported separately and were not included in the present report.Of the patients with syncopal episodes 16 also had heart failure. Of a totalof40 patients withheart failure 18had ischaemic heart disease. All the patients with narrow QRS complexes were paced because of syncope.It proved impossible to determine the time of onset of heart block in most patients, but the delay between the first StokesAdams attack and the start of pacing in 309 patients ranged from 13 years to one day (mean 18 months). In 18 patients

Ten‐year experience of 359 epicardial pacemaker systems: Complications and results

“…The m~in indication for pacing in this series was syncope cir near~syncope which affected almost 90% of patients. This finding concurs with that of other large series (Sowton'et al;1974). Approximately two-thirds of these patients had documented permanent/paroxysmal cOlllplete heart block.…”

Surgical complications of implanting pacemakers

“…Analysing the figures from 21 authors (Edhag and Lagergren, 1969;Witte et al, 1969;Fishman et al, 1970;Goldman et al, 1970;Seling and Sykosch, 1970;Shepard et al, 1971;Dixon et al, 1972;Imparato and Kim, 1972;Conklin et al, 1973;Homan van der Heide et al, 1973;Kantrowicz et al, 1973;Linschoten et al, 1973;McLaughlin et al, 1973;Mascarenhas and Center, 1973;Seremetis et al, 1973;Torresani et al, 1973;Codini et al, 1974;Sowton et al, 1974;Uhrenholdt et al, 1974;Williams et al, 1974), each of whom have reported 10&800 implantations in the past 5 years, the mean figure for surgical complications is 5.1 per cent in 7205 implants. (This incidence may be an underestimate as not all the reports indicated whether they included skin necrosis with infection.)…”

Annular Erythema Caused by Impending Pacemaker Extrusion

“…This is accompanied by local pain, occasionally severe, which is aggravated by deep breathing or pectoral muscle movement (3,7). Surgical intervention is needed to prevent pressure necrosis and extrusion of the generator through the skin (3,7,8).…”