SINCE the introduction of permanent transvenous cardiac pacemakers for the treatment of complete heart block in 1963,§ 18 Medtronic¶ pacemaker units have been inserted via the jugular approach in 16 different patients at the Strong Memorial Hospital. In 1 patient irregular pacing developed with recurrent Stokes–Adams attacks. In retrospect, pacemaker failure was considered to be due to catheter perforation of the right ventricle.Case ReportA 73-year-old woman with chronic intermittent complete heart block and Stokes–Adams attacks (S.M.H. 00–44–04) had a permanent transvenous pacemaker inserted via the right external jugular vein under fiuoroscopic visualization into the apex of the right . . .