DISORDERS OF RHYTHM APPEARING AFTER IMPLANTATION OF SYNCHRONIZED PACEMAKERS

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Abstract
Several heretofore undescribed arrhythmias that appeared after implantation of synchronized pace-makes in man have been described. The nomenclature that best fits these iatrogenic disorders of rhythm are: pacemaker escapes (from sinus control); dissociation between atria and pacemaker (A-P dissociation) with pacemaker captures (by the sinus node); the firing of the iatrogenic pacemaker by spontaneous A-V nodal beats and ectopic ventricular contractions (N-P and V-P rhythms, respectively). In one patient there was evidence in favor of a dual A-V conducting system: the normal junction used exclusively by the impulses propagating towards the atria; and the artificial communication which permitted transmission from atria to ventricles only. Finally, a rare phenomenon was presented where the implanted synchronized electronic pacemaker was paced by the human ventricle even though lead attachments in the heart were correct (an example of pacemaker malfunction).