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[Proceedings: Pacemaker implantation bradycardia and cardiac insufficiency. Preliminary report]
Insights
Pacemaker therapy offers better survival for bradycardia patients without heart failure. For those with congestive heart failure, outcomes vary, with severe cases showing limited improvement.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Context:
- Long-term effects of pacemaker implantation.
- 337 patients with bradycardia and congestive heart failure.
- Evaluation of outcomes with or without Adams-Stokes syncope.
Purpose:
- Investigate the long-term efficacy of pacemaker therapy.
- Compare survival rates across different patient groups.
- Assess improvement in cardiac function and overall survival.
Summary:
- Cumulative survival is significantly better in patients with Adams-Stokes seizures but without congestive heart failure.
- Patients with both conditions (Adams-Stokes and congestive heart failure) show moderate improvement.
- Highest mortality observed in patients with congestive heart failure as the sole indication for pacing.
Impact:
- Pacemaker therapy shows limited long-term benefit for bradycardia with severe congestive heart failure.
- Therapeutic indication remains crucial for drug-refractory or digitalis-intolerant cases.
- Positive response to temporary pacing supports long-term implantation decisions.
Abstract:
The longterm effects of pacemaker therapy have been investigated in 337 patients with bradycardia and congestive heart failure with or without Adams-Stokes syncope. The cumulative survival rate in patients with Adams-Stokes seizures without congestive heart failure (group I) is markedly better than in patients with Adams-Stokes seizures and congestive heart failure (group II). The death rate is highest in patients with congestive heart failure as sole indication for pacemaker implantation (Group III). In the patients from group II (mainly with slight to moderate decompensation) there was a higher percentage of improvement than in those from group III (chiefly with severe congestive heart failure), in whom cardiac decompensation improved in approximately half the cases. These findings do not prompt excessive enthusiasm about the longterm results in patients with bradycardia and severe congestive heart failure. The indication subsists where there is resistance to drug therapy, or digitalis intolerance, or where treatment with a provisional pacemaker produces good results.