The treatment of heart block in the elderly

Abstract

Thirty-nine patients over 75 years of age, with symptoms from chronic atrioventricular block, have been treated during a 5-year period. Seventeen patients were maintained on long-acting isoprenaline, and 7 have remained well and active for an average time of 8 months (range 2 months–2 years). Ten patients have died, 7 of them from Stokes-Adams attacks, after an average time of 9 months (range 2 days–3 years). Twenty-two patients were treated by long-term artificial pacing, and 15 have survived, most of them being kept fully active and well for an average time of 16 months. Seven patients have died, 5 from failure or complications of their pacing system, after an average time of 9 months (range 2 days–2.5 years). All elderly patients with symptoms from heart block should be treated initially with large doses of long-acting isoprenaline, and if this fails completely to control symptoms, long-term artificial pacing is recommended. The lower mortality and morbidity of long-term endocardial pacing makes this form of treatment worthwhile in elderly patients even if relatively incapacitated by other, unrelated, diseases.