[Stimucoeur--5 years' experience of a journal with a double impact].
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Biomedical subjects
Publications and source records attributed to B Dodinot.
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A national enquiry into the problems related to definitive cardiac pacemakers, carried out in 1975, has yielded certain essential findings: the number of first-time implantations of pacemakers has been increasing by about 20% per annum; 92% of electrodes are currently implanted by an endocavitary technique, thoracotomy having now practically been abandoned; 90% of pacemakers implanted in 1975 were threshold models, inhibited by a QRS complex; the indications have become progressively wider, and are essentially related with the various forms of bradycardia, most frequently those due to atrio--ventricular block. In 1976, we have now reached a figure of about 200 new implantations of pacemakers per million inhabitants; those using lithium are increasingly superceding the mercury and isotope models.
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In 1976, 10 years after the first successful implantations, the pacemaker technique is perfectly well accepted. Transvenous placement of the electrode is preferred in 95 % of the cases. Besides the 15 years nuclear power pacers (1970), conventional mercury pacemakers may reach a longevity of 4 to 5 years because of the reduction of the current drain. Lithium iodine seems a very promising source of energy. The mini-pacemakers with various iodine anodes are particularly attractive. The future is probably a well designed medium sized lithium pacemaker lasting more than 7 years. Patient follow-up is very much improved. All pacemakers exhibit an obvious rate reduction when their source of energy runs down. Therefore general practitioner and even the patients may detect this symptom. The main problem remains the lead resistance. The reduction of the frequency of pacemaker replacements and of the medical check-up makes life more simple for the pacemaker patient.
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The authors have studied the haemodynamic role of atrial systole in patients in the acute stage of a myocardial infarction, usually with left ventricular failure. Their main comparison is between the results obtained with stimulation of the right ventricle at a fixed rate and those obtained with bifocal stimulation, thus restoring the atrio-ventricular sequence. The authors discuss their results, and especially their findings of improvement in cardiac output and systemic arterial blood pressure. They raise the question of synchronous stimulation in cases of infarction with heartblock complicated by left ventricular failure, and also of re-establishing sinus rhythm in cases of arrhythmia of supraventricular origin.
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