Some clinical aspects of paired stimulation of the heart

Abstract

Not very long ago use of electrical currents for clinical purposes was considered- to say the least- an unusual and not very attractive idea. This view has changed rapidly in the last few years. The results of driving the heart with repetitive electrical stimuli during Adams-Stokes attacks or for the suppression of ectopic centres responsible for ventricular tachycardia, are gratifying. Fig. I demonstrates the effect of artificial single stimulation on a very active ventricular focus in a patient with coronary heart disease. Electric shocks across the heart or thorax are generally accepted in the treatment of ventricular fibrillation and atrial and ventricular tachycardia. This development helped to convince the clinician that electricity is something less than dangerous. In these conditions, electricity, applied either as one massive discharge or as repetitive single driving stimuli, has been used because of an inadequate cardiac output from a heart beating either toa slow or toa fast. lInder these circumstances, an increase i:l cardiac output and improvement of myocardial contractility are primarily a consequence of the return to normal of the heart rate.