Case 1-1982: Atrioventricular Heart Block

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To the Editor: In Case 1–1982 in the January 7 issue, Dr. Harthorne discusses the problem of what appears to be a widespread overuse of cardiac pacemakers.1 Although the cost of these devices — which would amount to more than $700 million per year for pacemaker implantation alone, according to Dr. Harthorne's estimate of the cost per unit — is an issue, this has not been my only concern. As compared with the expenditures for chronic hemodialysis, coronary-bypass surgery, and even our national defense budget, this sum, although not inconsequential, is not staggering. My criticism has been directed primarily at . . .

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