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September 14, 1984

Indications for Cardiac Pacing in Patients With Bradyarrhythmias: Do We Know All the Answers?

Author Affiliations

University of Southern California Los Angeles

JAMA. 1984;252(10):1327-1328. doi:10.1001/jama.1984.03350100057032

The past decade has witnessed a rapid increase in the use of pacemakers. In 1981, an estimated 118,000 pacemakers were implanted in patients in the United States.1 There is a concern that the use of pacemakers may be "excessive"; however, this theory has not been objectively documented. In the current issue of The Journal, a self-appointed committee2 has outlined criteria for permanent cardiac pacing in the treatment of bradyarrhythmias. This report is timely and merits careful reading. Although most of the recommendations made by Phibbs et al2 would meet with general approval, others need additional appraisal.

It should be recognized that the report does not evaluate (1) the role of cardiac pacing in the treatment of tachyarrhythmias,3 (2) the role of temporary pacing, or (3) the special problems of bradyarrhythmias in patients with an acute myocardial infarction.4

In many clinical situations, the indications for permanent