Implantable Transvenous Pacemakers: A Two and One-half Year Evaluation

Artificial pacing in management of complete heart block complicating acute myocaerdial infarction.

“…A substantial proportion of deaths are not due to the heart block itself, as many of them occur despite effective pacing or after the return of normal A.V. conduction (Julian et al, 1964;Paulk and Hurst, 1966;Parsonnet et al, 1967). However, pacing may be expected to prevent those deaths which are the result of asystole or bradycardia.…”

“…Various sites have been utilized, including arm veins (Harris and Bluestone, 1966 ;Siddons and Sowton, 1967), external jugular veins (Paulk and Hurst, 1966 ;Parsonnet et at., 1967), femoral veins (G. Sloman, personal communication, 1967, and percutaneously into the subclavian vein (Yoffa, 1965 ;E. J. Epstein, personal communication, 1967).…”

“…This causes discomfort to the patient and impedes nursing. The external jugular vein route is often time-consuming and technically difficult (Paulk and Hurst, 1966 ;Parsonnet et al, 1967). The percutaneous supraclavicular subclavian vein technique has in most cases proved to be rapid and simple, and, like the external jugular route, has the advantage of providing electrode stability.…”

“…There is general agreement that asystole is an indication for pacing, though this may not always be effective (Epstein et al, 1966;Paulk and Hurst, 1966;Parsonnet et al, 1967). The role of pacing in the management of bradycardia in complete heart block is less easy to define (Epstein et al, 1966).…”

“…Ventricular fibrillation is the major risk associated with pacing in acute myocardial infarction and occurs in from 5 to 21% of cases (Paulk and Hurst, 1966;Parsonnet et al, 1967).…”