Initial experience with the permanent implantable transvenous pacemaker: a report of 33 patients.

Thirty-three patients with heart block were treated by implantation of a permanent transvenous pacemaker. There were no deaths and few complications even though 25 of these patients were over 70 years of age. Follow-up examinations, including electrocardiograms, were done in all patients.The technique of the operation is discussed and the importance of performing it under fluoroscopic guidance in a proper surgical operating suite is emphasized. This arrangement may require the use of a portable image intensifier.This simple, effective procedure can be performed under local anesthesia and with safety, even in the elderly, frail or debilitated patient. Currently it is the authors' method of choice in the treatment of heart block; thoracotomy is now obsolete unless a synchronous pacemaker is needed or a permanent transvenous pacer cannot be inserted.