Esophageal ulceration and oral potassium chloride ingestion.

ESOPHAGEAL ULCERATION AND ORAL POTASSIUM INGESTION 463 Thus, the role of electrical management may be more desirable in these situations. Pacemaker usage offers a mode of therapy which does not depress fetal heart rate or contractility. Pacemaker therapy during pregnancy was first reported by Shouse and Acker in 1964. Since that time, approximately nine additional cases have been reported, all, significantly, without maternal or fetal mortality. The indication for pacing has been complete heart block, congenital or acquired, occasionally associated with yentricular tachyarrhythmia. Prior to pacemaker availabiity, heart block in pregnancy was accompanied by a 6 percent incidence of heart failure, 9 percent incidence of toxemia, a 13 percent maternal death rate and 15 percent fetal loss.b0 These statistics are not necessarily the result of Stokes-Adams episodes, but may represent the potential role of brady-arrhythmias for accentuating heart failure and anoxic injury to the fetus.1#{176} The only morbidity associated with pacemaker use has been with permanent units installed prior to pregnancy. These have included local irritation with ulceration from a unit located in the breast region,5 transient pacemaker competition,9 and temporary loss of capture which requireci an increase in milliamperage. No episodes of thromboembolism occurred. In summary, pacemaker therapy offered a favorable alternative to drug therapy in the treatment of a refractory arrhythmia during pregnancy. There appears to be no associated fetal morbidity or mortality.