Value of pacing in cardiac failure associated with chronic atrioventricular block.

Abstract

SUMMARY The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed.

The downside of permanent cardiac pacing, short-term gain for long-term pain?

“…Approaching 3.5 million permanent pacemakers have been implanted since the 1960s, with implant rates worldwide ranging from 250 to 800 per million of the population per annum, leading to between 1000 and 3000 patients undergoing regular follow-up in a typical pacemaker center [1,2,101]. That permanent pacing benefits these patients in terms of both symptom relief and mortality benefit is beyond question, particularly when higher orders of atrio-ventricular (A-V) block are present [3,4]. Numerous indications for permanent pacing have grown from data on such patients gathered in the 1970s and 80s, typically governed by national guidelines [101] and covering a range of rhythm disorders extending beyond classical A-V conducting disease.…”

Age, sex, and ischaemic heart disease as prognostic indicators in long-term cardiac pacing.

“…These findings accord with those of Simon and Zloto (1978) who were also able to identify hypertensive heart disease and congestive failure as indicators of a poorer prognosis. The malign significance of heart failure has recently been highlighted by Hetzel et al (1978).…”

Ventricular pacing improves exercise tolerance in patients with chronic heart block.

“…3 We have used a simple six minute walking test8 9 to assess the effect of ventricular pacing on exercise capacity in a group of patients with heart block whose only presenting symptom was breathlessness.…”