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Advantages of Leaving Well Enough Alone

David A. Kass, MD

JAMA. 2002;288:3159-3161.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The implantable cardiac pacemaker was first introduced in 1960, with a primary goal of maintaining adequate heart rates in individuals with symptomatic bradycardia. In such patients, single-ventricle stimulation was effective even though it was suboptimal from a physiologic standpoint. However, with sustained bradyarrhythmia requiring frequent ventricular activation, problems with this approach became apparent. Ventricular pacing disrupted the normal temporal sequence of atrial-ventricular systole, resulting in AV-dissociation, mitral and tricuspid valvular regurgitation, and cardiac cycles with variable filling and thus systolic dysfunction. For patients in whom cardiac performance was compromised, loss of effective atrial contraction and elevated filling pressures worsened symptoms.

The first solution to this problem came in the late 1970s with development of dual-chamber pacing, whereby native atrial activation was either sensed or provided if it did not occur at a preset rate, and subsequent ventricular activation was then timed to maintain more physiologic coordination . . . [Full Text of this Article]

Author Affiliation: Johns Hopkins Medical Institutions, Baltimore, Md.

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