Electronic cardiac pacing has progressed rapidly from the experimental stage to that of accepted, almost standard, procedure. Pacemakers are currently used not only for cardiac arrest complicating myocardial infarction or for the prevention of Stokes-Adams syncope in ambulant patients, but also for some dysrhythmias which—though not directly life-threatening—cause symptoms, decrease cardiac output, and respond poorly to drugs. No longer merely a temporary expedient, electrical pacing is at the stage where refined techniques and complex apparatus compete for efficiency and durability of performance. And though competing techniques and devices are much too new to permit definitive evaluation, some appreciation of their relative advantages and disadvantages can be gleaned from recent reports.
There are two approaches to pacemaker implantation—transthoracic epicardial and transvenous endocardial. Studying these approaches, as reflected in the clinical course of two groups of elderly patients, Stafford et al1 noted five postoperative deaths and 12 complications in 47 patients