An intracardiac pacemaker in Adams-Stokes attacks in acute myocardial infarction.

Abstract

COMPLETE HEART BLOCK with Adams-Stokes seizures is an uncommon, but grave, complication of acute myocardial infarction, with at least a 50% mortality rate.¹During the acute phase of myocardial infarction, atrioventricular block may be transient.^{1, 2}If a patient is successfully maintained during this period, and reverts to regular sinus rhythm, the long-term mortality is no greater than in those postinfarction patients without associated heart block.³ Recommended drug therapy for Adams-Stokes attacks in the immediate postinfarction period includes epinephrine or isoproterenol hydrochloride, adrenocortical steroids, and intravenous molar sodium lactate.^1,4,5With all of these medications, there may be a failure of response, or the patient may become refractory to treatment. The external pacemaker^{6, 7}has provided a dramatic advance in the general management of Adams-Stokes attacks. More recently, small, portable, internal electronic pacemakers, attached by a venous intracardiac catheter electrode inserted into the right ventricle,^8,9have