Editorial; Long-life cardiac pacemakers.
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The authors report on a 74-year-old female patient who revealed Adams-Stokes attacks and was supplied by an R-wave triggered external pacemaker. The patient showed intermittent total AV-block. A frequency of 26 beats was observed. Hypothyroidism was recognized as the cause of this disturbance of cardiac rhythm. After treatment with triiodothyronine the bradycardia disappeared and the external pacemaker could be removed. This case is reported for demonstrating a disturbance of the rhythm caused by hypothyroidism and which is successfully treated by temporary pacemaker and specific drug therapy.
Myotonic dystrophy is a well known cause of cardiomyopathy. While various cardiac conduction abnormalities have been described in patients with myotonic dystrophy, so far only sporadic cases of Stokes-Adams attacks have been reported. Of 27 patients with this disease various conduction disturbances were detected in 17 (63%), 5 of whom presented with Stokes-Adams attacks and were found to have intracardiac conduction defects. The prognosis in four of the five patients was greatly improved with permanent pacemaker implantation.
In spite of general complacency about first-degree heart block in acute rheumatic fever, abnormal conduction with dysrhythmias, occasional complete heart block, and, rarely, Stokes-Adams attacks are important early signs of acute rheumatic fever and may precede other signs. Every person with episodic fainting is entitled to an ECG, and frequent ECGs are imperative in any case of rheumatic fever with signs of arrhythmias. Changing atrioventricular block necessitates continuous monitoring for dysrhythmias. A 13-year-old boy who appeared with Stokes-Adams attacks secondary to acute rheumatic fever was successfully treated by temporary pacing.
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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