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One-hundred and eighty-one patients with chronic and with intermittent high-grade atrioventricular block (AVB) were studied retrospectively. Seventy-one were treated with fixed-rate, 51 with demand-type pacemaker, 59 were treated conservatively. Observation time was three years minimum and 14.5 years maximum. The mean age was about seven years higher, and 8.7% more patients had chronic AVB in the conservatively treated than in the pacemaker-treated group. About 12% more patients had Adams-Stokes attacks in the pacemaker group than in the conservatively treated group. There were 7% more patients with coronary heart disease (CHD) in the pacemaker group, and 10% more with aortic valve disease among the conservatively treated. Totally 4.4% of the patients had a calcification of the mitral annulus fibrosus. The two groups were comparable as regards functional class (NYHA) and heart size. Survival showed 31% more sudden deaths in the conservatively treated than in the pacemaker group. Sudden deaths were not more frequent among the patients with CHD than in those without. Long-term survival showed the more favourable result for the patients with than without pacemaker treatment. There were eight (11.3%) unexplained sudden deaths among the patients treated with fixed-rate pacemaker, only three (5.9%) among those treated with a demand unit. The fixed-rate and the demand units showed a mean longevity of 37.2 and 34.6 months, respectively. more...

A patient with multiple myeloma and amyloidosis was admitted to hospital following successful cardiopulmonary resuscitation at home. No disturbances in heart rhythm were seen during the first 48 hours of continuous telemetric ECG recording. The patient died from ventricular asystole due to complete atrioventricular block, while he was on a 24-hour Holter monitoring the fifth night in hospital. Patients with known cardiac amyloidosis and syncope should undergo long-term ECG recordings, preferably by telemetry. Repeated registrations may be necessary to discover disturbances in heart rhythm. more...

Of 693 patients on permanent pacemaker treatment between 1962 and 1981, 282 (40.7%) were above the age of 75. Of this number, 142 patients were 75-79 years, 95 80-84 years and 45 85-93 (mean 87) years old at the time of the first pacemaker implantation. The patients were followed for 13-154 months (mean 37.1) with special attention being paid to morbidity and mortality after the implantation. Complications occurred in 65 (23%) of the elderly patients, with no significant difference between the three age groups. Excessive threshold rise with stimulation failure (6%) and infections or skin erosions (4.9%) were the most frequent complications. Mortality increased in all age groups during the first 6-12 months compared with the age- and sex-matched Norwegian population. Five-year survival rates were 56, 32 and 25% respectively. We conclude that cardiac pacemaker treatment in the elderly is a safe symptom-relieving therapeutic procedure and that the prognosis for these patients is similar to that for their fellow senior citizens after the first year of treatment. more...

During the last decade implantation of permanent pacemakers has become the treatment of choice for patients suffering from the sick sinus syndrome (SSS). We have followed up 112 SSS patients treated with permanent pacemakers in Haukeland Hospital in the period 1966--76. The pacemakers were later removed from three of the patients. In the remaining 109 patients the SSS was characterized by tachy-bradyarrhythmias (TBA) in 44 and bradyarrhythmias (BA) in 65. Before implantation, 68 patients had syncopes and 27 severe dizziness. After implantation, symptomatic improvement was apparent in 104 patients; only three still had syncopes. During the follow-up period (mean 34.4 months), 29 patients died (yearly mortality 9.3%). There was no significant difference in total mortality between patients with TBA and with BA. Concomitant disturbances in atrioventricular (AV) conduction occurred in 35.8% of the patients. Among 79 of 80 patients still alive, five had developed total AV block, 19 had stable atrial fibrillation, 12 of these were possibly pacemaker-independent (ventricular rate greater than 60/min). Systemic embolization was observed in 16 patients, more frequently in the TBA (12/44) than in the BA group (4/65) (p less than 0.001). It is concluded that permanent pacemakers have an excellent symptomatic effect in patients with SSS. The prognosis is mainly determined by the presence or absence of coronary heart disease and/or heart failure. more...

The effect of prazosin in congestive heart failure was assessed in 10 patients (age 39--69) years) with ischemic heart disease or cardiomyopathy in functional class II-IV (NYHA). All patients were treated with digitalis and diuretics in optimal doses. Mean (+/- S.E.M.) cardiac index (CI) was 2.2 +/- 0.2 l/min/m2 before and 2.3 +/- 0.1 one hour after oral administration of 2--4 mg prazosin (given as tablets) (p less than 0.10). Mean pulmonary capillary wedge pressure (PWP) fell from 24 +/- 4 to 20 +/- 4 mmHg (p greater than 0.10). Prazosin seemed to have a more beneficial effect on patients with markedly elevated PWP or reduced CI before prazosin administration. The effect of prazosin on heart rate and systolic blood pressure was insignificant. During a follow-up period of 1--20 months (mean 7.3), 2 of 7 patients treated with prazosin (2--4 mg daily) improved their clinical condition, one patient was unchanged and 4 patients died in progressive cardiac failure. The results indicate that some patients with severe heart failure may benefit from prazosin when conventional treatment has failed. more...