Istitte For Muscl Disease , Inc . THE MANAGEMENT OF HEART BLOCK

In 1952, Zoll described a technique for artificial pacing of the heart. The method employed electrodes placed on the chest wall and electrical impulses of 2 msec. duration at 25-150 volts. Although this indirect technique proved successful in resuscitating and temporarily maintaining life in patients with Stokes-Adams attacks due to asystole, the high voltage required produced skin burns and painful contractions of the muscles of the thorax. Other methods were developed for the direct stimulation of the myocardium with low voltages, and permanent pacing of the heart with small pacemakers is now routinely performed (Bellet et al., 1960; Chardack, Gage, and Greatbatch, 1961; Elmqvist and Senning, 1960; Davies, 1962; Kahn et al., 1960; Landegren, 1962; Lillehei et al., 1960; Stephenson et al., 1959; Weirich et al., 1958; Zoll et al., 1961). Reports on the success of long-term pacing by many different systems have now appeared (Furman et al., 1961; Levitsky et al., 1962; Siddons, 1963). While artificial pacemaking is life saving and permits a return to a normal way of life in most cases, numerous problems have arisen in the maintenance of this artificial system. It is for this reason that we propose to describe our experiences in the management of heart block over the past four years at St. George's Hospital, of which some have been previously reported by Portal et al. (1962) and Siddons (1963).