Experience of endocardial pacing in eighty-two patients with atrioventricular block after myocardial infarction is described. A unipolar pacing wire was passed into an antecubital fossa vein and passed into the right atrium and wedged into the apex of the right ventricle under radiological control using an image intensifier. All patients were attached to an external demand unit set at 60/min which will pace if there is asystole longer than 1 sec. The disadvantages of pacing are discussed.
A fall in mortality occurred from 71% of unpaced patients to 38% of thirty-seven patients where demand pacing was given. When suppressant drugs (lignocaine, procainamide and quinidine) were given in addition to pacing the mortality dropped to 11% of twenty-seven patients. The disadvantages of pacing are few and it is considered that suppressant drugs are only used with safety when a pacing system has been installed.
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