Surgical management and problems of heart pacing

Experience with 40 patients and 150 pacemakersss is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications. The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resion fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by 'demand' units in large electromagnetic fields.