In this paper the relationship between the clinical effect of permanent pacing and the cause of death is discussed.
Of 63 patients with implanted pacemakers, 8 died. The causes of death were cerebellar hemorrhage, sudden death, unknown cause, senility, pneumonia, cerebral embolism, myocardial infarction and mesenteric embolization. The mortality of our paced patients was 12.7 per cent. Post-operative mortality (within 30 days of surgery) was 1.6 per cent (one case). However, the cause of this death was unrelated to the pacemaker (myocardial infarction).
When the patients who have died are compared to the living patients, with relation to the average age at the time of initial pacing, we find that the former group was older than the latter. This may be due to natural history.
Electrocardiographic findings reveal that mortality in the supraventricular arrhythmic group was slightly higher than in the atrio-ventricular block group. In the supraventricular arrhythmic group, systemic embolization as the cause of death was remarkable. This may be due to the irregularity and/or stasis of the blood flow in the atria.
Hemodynamic improvement with pacing was quite obvious not only i n the living, but also i n the patients who had died.
After pacing, no Adams-Stokes attacks or death due to congestive heart failure ever occured.
Although patients derive hemodynamic improvement from pacing, it is no guarantee that they will not die from causes unrelated to the pacemaker. Pacing, therefore, is not always effective in prolonging life.
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