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Lessons From Pacemaker Implantations

Xavier S. Dalle, MD
JAMA. 1966;195(5):395. doi:10.1001/jama.1966.03100050103037.
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To the Editor:—  In their paper (194: 1133, 1965) Taber and Webb state "If this irregularity [interference of the heart's intrinsic pacemaker with the artificial pacemaker in intermittent atrioventricular block] produces symptoms, it may be necessary to increase the pulse-generator rate or current strength to completely 'capture' " the heart. Being faced with the same problem in short-term transvenous pacing in a Coronary Care Unit (Presbyterian Hospital in Philadelphia), we would like to comment on this statement in order to avoid possible misininterpretation.Conducted supraventricular rhythm, in the presence of an artificial ventricular pacemaker results in a type of artificial parasystolic arrhythmia. A change of rate of either pacemaker will usually result in a change of the interference pattern, but reasonable pacing rates ( 90 to 100 beats per minute) do not usually, although it sometimes happens, result in complete "capture" (Fig 1) except if accrochage or spurious synchronization occurs.1-3 Complete


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