In the past decade, remarkable advances have been made in the management of patients with heart block and Adams-Stokes disease. Not only do we now have a better understanding of the pharmacological treatment of this condition, but application of electrical stimulation to the heart by a variety of means also now prolongs the lives of many patients with Adams-Stokes disease who would not have survived a few years ago.
In 1959, Furman and Schwedel1 first reported clinical use of a unique means of electrical pacemaking. This method consisted of delivering the stimulating current to the heart through an indwelling electrode inserted from a peripheral vein of the arm into the chamber of the right ventricle. Since then, their group has accumulated experience with this technique and has demonstrated the usefulness of such an electrode, introduced preferably through the right external jugular vein, in the treatment of heart block.2