The treatment of complete heart block with an implanted, controllable pacemaker.

THE INCIDENCE of atrioventricular dissociation and Stokes-Adams seizures has been variously estimated. Rowe and White reviewed 160,000 electrocardiograms taken at the Massachusetts General Hospital from 1925 to 1955 and discovered 350 patients who showed complete atrioventricular dissociation. Penton, Miller, and Levine reported 251 cases of complete heart block during a 42 year period. In Rowe’s series, Stokes-Adams syndrome occurred in 30 per cent of the patients, whereas Penton reported an incidence of 61 per cent. At Maimonides Hospital of Brooklyn, 44 cases of Stokes-Adams syndrome were seen during the 5 year period 1956 through 1960. By far the most common cause of complete heart block in the older age group is coronary artery disease. There is an increasing number of patients who have permanent heart block subsequent to open heart surgery. Since 1952 when Zoll first suggested the use of an external electric stimulator in the treatment of intractable, complete heart block, there has been increasing interest in this therapeutic approach. Weirich, Gott, and Lillehei described a method of implanting electrodes in the myocardium and stimulating the hearts of patients suffering from surgically induced heart block. Glenn and his associates reported a method of implanting subcutaneously a tuned circuit driven from the outside by a radio-frequency