THE USE of implantable electrical cardiac pacemakers has improved the longevity and subjective status of patients with heart block. The implantation operation is relatively simple, with a low mortality and morbidity.1,7 Unfortunately, the primary implantation may initiate a series of additional reoperations to maintain a good clinical result.
In an experience with 38 patients treated by pacemaker implantation, we have performed 15 additional thoracotomies and 25 extrathoracic operations to maintain electrical control of the heart rate. We cite this experience not as indictment of this mode of therapy but rather to emphasize the necessity of close observation and the essentiality of willingness to reoperate if required by a loss of electrical control of the heart.
During the past 4½ years, 38 patients with heart block have been treated by pacemaker implantation. The extremes of age were 5 and 88 years; three quarters of the patients were 60 years of