The results of pacemaker therapy in the Regional Hospital, Orebro, during its first 10 years are presented. In general, patients with a history of temporary heart failure either before or at the time of implantation, had a better prognosis than those with such a history. Myocardial infarction had a detrimental effect on the prognosis in the first year of the patients pacing, but not thereafter.
Two methods were used to sterilize pacemakers recovered for reimplantation in other patients. In a series of 50 reimplantations there was no battery or pocket complication which could be attributed to these methods. We believe that reimplantation is justified especially as the economic factors will become much more important with the new long-lasting, hermetically sealed lithium pacemakers.
The study comprises 375 patients who had received an endocardial pacemaker electrode primarily. A stylet electrode of the Medtronic type was used in 165 patients and of the Elema type in 79 patients. Elema's flexible electrode model 588 EMT was used in 131 patients. The total number of electrode complications was surprisingly high. In 92 out of the 375 patients, 141 serious episodes of pacing failure occurred during the observation period of from 6 to 42 months. The complication rate increased with pacemaker function time. The stylet electrodes gave the highest complication rate. The choice of vein for introducing the electrode into the heart seems not to affect the complication rate significantly. Nor did the initial threshold value of stimulation influence the complication rate to any marked degree. The pacemaker manufacturers have devoted much effort to producing long-life impulse generators but there is also a great need for well-functioning long-life electrodes.
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