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The number of pacemaker patients is permanently increasing. In case of dysfunction of the pacemaker they are demanding emergency care. All doctors should be informed about first aid in those cases.
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A comparison between the life expectancy of patients with pacemakers and that of a control population of similar structure shows a parallel course, although originally, after a postoperative phase of 2 months, the mortality rate of the patients with pacemakers was higher. Today the results are considerably better. Implantation of pacemakers is one of the greatest cardiological advances in the last 10 years for the effective treatment and prevention of cardiac arrest in atrioventricular block. The significance of this type of therapy becomes understandable if the fact that the mortality of Adams-Stokes attacks used to be about 50% is taken into consideration. In France, about 5000 persons each year have Adams-Stokes attacks.
The occurrence of bradycardial arrhythmias in the course of myocarditides of different etiologies is reported. The many different variations in the course of the disease are presented with reference to seven typical examples, and also the indications and risks for pacemaker therapy and its predominantly successful but sometimes, in the last analysis, unsatisfactory use.
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"Vagal reactions" may follow sudden emotional or physical strain in "vagotonic individuals" and are usually benign. In the case described, emotional stimuli caused life-threatening vagal reactions in a "healthy individual." Implantation of an artifical pacemaker was necessary to control the attacks.
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