To the Editor.—
Dr. Margolis writes (212:1524, 1970) that many patients with complete heart-block do well if "given the chance" and therefore use of the pacemaker can be postponed. He bases this decision on observation of 15 patients, and three references to the available literature. Apparently there is some confusion by your correspondent in regards to the distinction between emergency temporary pacing and permanent pacing. Although all of his patients may have been candidates for temporary pacing, ie, insertion of a catheter electrode to the right ventricle to be attached to an external pacemaker, only one patient (the third in the list) appeared to be a candidate for permanent pacemaker implantation. This patient eventually died of a second myocardial infarct two years later. Would his death have been prevented by adequate pacing?There is ample documentation of the natural history of complete heart-block. Two issues of the Annals of
Parsonnet V. Pacemakers in Complete Heart-Block. JAMA. 1970;213(9):1498. doi:10.1001/jama.1970.03170350064025
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