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PubMed1975

[Survival time of patients with cardiac pacemakers (author's transl)].

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.

Adams-Stokes Syndrome↗
PubMed1975

[Pacemaker treatment in myocarditis (author's transl)].

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.

Adams-Stokes Syndrome↗
PubMed1977

Life-threatening "vagal reaction" to emotional stimuli.

"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.

Adams-Stokes Syndrome↗
PubMed1976

[Isoproterenol in the emergency treatment of cardiac stimulus conduction].

Continuous infusion with isoproterenol (mean dose 2 mug/min) was carried out for periods of a few hours to a few days in 22 patients recurrent Adams-Stokes syncope. In all cases, an improvement leading to or in the direction of physiological cardio-circulatory conditions was noted. Undesired side-effects foreseeable as the result of beta-adrenergic stimulation were not observed. Isoproterenol is more active than metaproterenol and is to be preferred on this account. It is indicated in Adams-Stokes crises due to conduction disturbances when pacemakers cannot or should not be fitted, or as a prelude to their application.

Adams-Stokes Syndrome↗
PubMed1976

Recurrent electromechanical dissociation due to severe underlying coronary heart disease.

Recurrent electromechanical dissociation, eventually fatal, presented as Stokes-Adams-like syncope in a patient with severe underlying coronary heart disease. Mechanical function was probably suppressed because of myocardial ischemia due to recent occlusion of the proximal right main coronary artery; the left main coronary artery had been occluded previously. Spasm of the proximal right coronary artery may have accounted for his recurrent attacks of pain and syncope. It is suggested that this clinical picture has a grave prognosis, demanding urgent therapeutic measures. While these measures are likely to be more hazardous than usual, the grave prognosis and potential for therapeutic success make them well worth the risk.

Adams-Stokes Syndrome↗
PubMed1976

[Pregnancy in women with atrioventricular block. 13 cases].

Thirteen women aged between 18 and 37 years and suffering from atrio-ventricular block had 36 pregnancies. Foetal prognosis was excellent and the pregnancy quite unaffected by the block in 9 cases. In 4 women, Stokes-Adams attacks occurred. In one case from some time ago therapeutic abortion was necessary. Temporary pacing at the time of delivery was used in one case and a permanent pacemaker in one patient. The problems posed by the insertion of a pacemaker in a woman of childbearing age are discussed.

Abortion, Therapeutic↗
PubMed1978

Long-term follow-up after cardiac pacing in bradyarrhythmias.

Fifty-nine patients aged 39-80 years underwent implantation of a cardiac pacemaker and were followed for up to 9 years (average duration of pacing 39 months). Atrioventricular conduction disturbances (complete atrioventricular block, 2 : 1 atrioventricular block, bifascicular block, and atrial fibrillation with slow ventricular rate) were present in 49 patients and sick sinus syndrome (sinus arrest or sino-atrial block, and bradycardia-tachycardia syndrome) in 10. Pacing was required because of Adams-Stokes attacks in 41 patients, 2 of whom also had congestive heart failure. It was required in 6 because of frequent dizziness, in 10 because of congestive heart failure, and in 2 because of low cardiac output. The symptomatic improvement after cardiac pacing was well recognized in most of our patients, and 32 (54 percent) of the 59 patients pursued normal physical and daily activity. Although the efficacy of pacemaker therapy was of limited value in some patients with congestive heart failure or underlying or coexisting diseases, the beneficial effects following pacemaker implantation were: (1) abolishment of transient neurologic symptoms such as Adams-Stokes attack, (2) relief from a constant fear of a recurrence of an Adams-Stokes attack or sudden cardiac death, and (3) improvement in restricted physical activity due to low cardiac output. Thus, we conclude that pacemaker implantation in most patients with bradyarrhythmias is beneficial not only for the treatment of the acute problem but also because it prolongs life and greatly enhances its quality. However, in spite of the beneficial effects after pacemaker implantation, we still observe a number of complications connected with the use of a permanent pacemaker. Therefore, our policy is to implant a permanent pacemaker following the execution of sufficient studies of the bradyarrhythmia and the etiology of symptoms, and then under taking long-term follow-up of the patients.

Adult↗