J.Jpn. Surg. Soc.. 81(9): 1020-1025, 1980

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Report on the annual meeting

MODERN TREND OF CARDIAC PACING IN THE TREATMENT OF ARRHYTHMIAS

Ventricular pacing, even though of demand type, does not restore the physiological sequence of cardiac output. In many cases with A-V block, sinus node function is preserved and remains physiological; in others, the abnormality of sinus node behavior is only intermittent and in many patients with sick sinus “syndrome the A-V conduction system is normal.
Cardiac pacing at present days has been moving toward more “physiological pacing” or more “ophisticated pacing”. In other words, the aims of cardiac pacing are not only the life saving or prevention of sudden death of the patients with bradyarrhythmia but also the improvement of quality of the patients lives.
Technological advances and improvement now allow the programmable pacing for “physiological pacing” in performing to vary almost all parameters of the implanted pacemaker from the outside of the body. Some “physiological pacemakers” allow atrial sensing and pacing and synchronization of ventricular activity to restore the normal electrical sequence of the heart.
Further, trepanation technique of the sternum for the implantation of atrial electrode makes use of these systems practicable.
This paper proposes a new theory of mechanism of the rapid atrial stimulation for the termination of supraventricular tachycardias using the paired stimulation principle and also the effective stimulation conditions on the basis of the new theory. According to this, the paired atrial stimulation with an interval of 50 to 75% of R-R interval can terminate the re-entrant supraventricular tachycardia persistently and effectively.

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