Permanent Atrial Pacing

Atrial pacing, while recognized to have therapeutic indications, has not been easily accomplished because there have been no simple and reliable electrodes available. A short parasternal mediastinotomy provides sufficient exposure for easy application of "pinch-on" electrodes to the presenting fold of the right atrium. Special attention is given to the recording of electrical indexes of the pulse generator and electrodes (voltage threshold, calculated impedance, and intrinsic amplitude of the P wave) with testing apparatus, most of which is conveniently brought to the operative table. Less than ideal results are not accepted, and immediate replacement of the electrodes into adjacent areas of the atrial myocardium is performed with ease. Five patients have tolerated the procedure without complication. These electrodes and this operative procedure have proved to have been successful over a six-month term of observation.