Abstract
Of fifty patients with complete heart block complicating myocardial infarction, twenty-three were initially managed on drug therapy (isoprenaline, corticosteroids, and the glucose-insulinpotassium regimen) and the remainder had a pacing electrode inserted. Mortality was lower in the paced group (37% as against 61%). Prognosis depended on the degree of circulatory disturbance, age, site of infarction, and on the interval between infarction and the development of heart block. The effect of pacing was notable in patients who had had Stokes-Adams attacks-six deaths in seven such patients treated with drugs, five deaths in fourteen patients who were paced. It is suggested that patients with complete heart block who have severe hypotension or cardiac defeat or who have had Stokes-Adams attacks should be paced immediately.
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