Permanent Pervenous Atrial Pacing From the Coronary Vein

This report details our clinical experience during a 12 to 63 month follow-up period in 30 patients with permanent pervenous atrial pacemakers implanted in the coronary vein prior to May 1972. Indications for permanent atrial pacing included 20 patients with symptomatic sinus bradycardia, seven with atrial brady-tachy syndrome refractory to pharmacologic therapy, and three patients with atrial overdrive suppression for intractible ventricular arrhythmias. The average duration of atrial pacing was 29.2 ± 2.4 ( sem ) months, median 24 months. A bipolar electrode was used in 28 patients and a unipolar system in two. The atrial signal was of sufficient amplitude (>1.5 mV) to permit atrial demand pacing when required. The atrial pacing threshold averaged 2.0 ± 0.2 ma initially and increased by less than 1.0 ma at the time of battery replacement 20 months later. Only four of 30 patients (13%) developed pacemaker related problems during the 879 pacing months of this follow-up period. Coronary vein perforation or thrombosis was not observed, and there were no pacemaker related deaths. The coronary vein provides a safe and effective electrode location for long-term permanent pervenous atrial pacing.