The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Patient Selection for Permanent Cardiac Pacing

[+] Article and Author Information

Charlottesville, Virginia

Ann Intern Med. 1969;70(2):263-267. doi:10.7326/0003-4819-70-2-263
Text Size: A A A

Selection of patients with complete heart block for permanent artificial pacing requires an estimate of the risk of death from heart block in untreated, "minimally symptomatic" patients with block. Of 26 such patients who were not given pacemakers at their initial evaluation, 12 remain minimally symptomatic after an average of 3 years after consideration for pacing. Nine patients subsequently developed symptoms, at which time artificial pacing was provided uneventfully. Five died suddenly and unexpectedly of apparent cardiac arrhythmia. The five patients who died had shown some premonitory symptoms and variation in ventricular activation focus to a greater extent than those 12 who had survived without pacemakers.

During the same time 33 patients received artificial pacing because of recurrent syncope or equivalent symptoms of circulatory failure. Of this group there were no operative deaths, three patients died later of unrelated disease with normal pulse rates, and two died with probable rhythm disturbance.

This experience indicates that, while most patients with atrioventricular (AV) block provide sufficient symptomatic warning to permit pacing when needed, the risk of sudden death even in the minimally symptomatic patient is considerable, and the risk of artificial pacing has been less. Any patient who has persistent or recurrent episodes of high degrees of AV block, if accompanied by any related symptoms or spontaneous ventricular irritability, should now receive a permanent, artificial pacemaker.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Survival with cardiac-resynchronization therapy. N Engl J Med 2014;371(5):477-8.
Survival with cardiac-resynchronization therapy. N Engl J Med 2014;371(5):477.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.