Electrical Pacing of the Heart

The indications and techniques for cardiac pacing in 70 patients treated since 1963 are discussed. Endocardial pacemaking has been established as the treatment of choice, and a number of different types of pacemakers have been employed. The problems associated with wire fracture have been largely overcome, and the two remaining outstanding problems are (i) electrode stability in the right ventricle and (ii) premature generator battery failure. The first problem can be minimized by the use of a two-stage procedure, allowing time for the catheter to become adherent to the endocardium before implanting the generator; while the second problem can be minimized by the use of regular electronic testing of the implanted pacemaker. White current models of implanted units are proving reliable up to two years after implantation, this period is still generally unsatisfactory, and developmental work is proceeding in an attempt to produce generators with a longer battery life, employing either standard components or an isotope energy source. It is clear that the initial limited application of pacemaking in the treatment of patients with complete heart block and either Stokes-Adams attacks or heart failure should be expanded, to utilize the technique of cardiac pacing for other arrhythmias which are not adequately controlled by drug therapy alone.