Artificial Atrial and Ventricular Pacing in the Treatment of Arrhythmias

Five patients with various types of arrhythmias refractory to standard therapeutic agents are presented, and the therapeutic approach to the control of these arrhythmias is outlined. The possible electrophysiologic mechanisms operative are discussed in detail. The most important aspect of artificial pacing is the prevention of arrhythmias that are incompatible with life: ventricular asystole and ventricular fibrillation. Important additional benefits of pacing include the control of less threatening but symptomatic tachyarrhythmias and bradyarrhythmias and the preservation of the best hemodynamic and electrophysiologic relationships possible. Pacing allows the concomitant use of drugs to control tachyarrhythmias without fear of suppressing intrinsic impulse formation and producing asystole. Because of the varied modes of pacing available, it is imperative that each patient be evaluated carefully and that a type of pacing be selected that best serves his needs.