Long–term Pacing in the Management of Bradyarrhythmias: Seven Years’ Experience

The Alfred Hospital experience in the use of implantable pacemakers over a seven-year period in 70 cases of symptomatic heart block is presented. Eighty-five per cent of patients were alive at follow-up at one year; this survival rate is compared with the 50% to 60% survival of such patients who do not receive the benefit of pacing. Both the epicardial and the transvenous route of achieving long-term pacing have been used; the incidence of complications is roughly equal with either technique. Whilst the transvenous route has a higher incidence of complications early after insertion — namely, displaced electrodes and rising endocardial threshold — the incidence of long-term complications is considerably reduced. The current policy of the department is to use a ventricle-triggered unit with transvenous placement of the electrode in all new patients presenting for long-term pacing.