[Additional pacemaker indications].

In addition to the widely accepted criteria for the implantation of a permanent pacemaker (bradyarrhythmias combined with syncope, cardiac decompensation, angina pectoris etc.) ther are borderline situations where the decision for a pacemaker is less easy: 1) marked bradycardia with only minor symptoms, 2) syncope without appropriate electrocardiographic abnormality, 3) bifascicular blocks, 4) tachyarrhythmias refractory to medical therapy. In connection with these situations, 3 syndromes are discussed with particular reference to the indication for pacemaker: A) hyperactive carotid sinus reflex syndrome, B) sick sinus syndrome, C) fascicular block. A pacemaker is a fairly safe method of therapy (although with some complications) which should not only be used as a last resort (e.g. in severe Adams-Stokes syndrome) but in patients whose condition may improve after a pacemaker implantation or be prevented from getting worse. Patients with pacemakers have a mean survival rate of 80-90% after 1 year and of 50-60% after 5 years.