Preventive Pacemaking

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Abstract
Although pacemakers have been used clinically for almost 25 years,1 we still do not know in all cases just when to install them. No physician would hesitate to prescribe a permanent pacemaker for a patient with syncope and documented third-degree atrioventricular block. The device will prevent fainting, provide a more physiologic heart rate, and prolong life. But must one wait until a potentially fatal event such as syncope occurs to take definite action?When atrioventricular block develops, some form of heart disease has destroyed the ability of the specialized conducting system to transmit electrical impulses through the atrioventricular node, the . . .

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