Dynamic electrocardiography and ventricular pauses of 3 seconds and more: etiology and therapeutic implications.

A total of 2350 consecutive Holter recordings revealed that 53 patients had ventricular asystole of 3 seconds or more. The diagnoses based on the longest pauses were: sinus arrest in 19; AV block in 5; slow atrial fibrillation in 29. Symptoms occurred in 45 and were absent in 8 patients. Associated heart disease was present in only 33 cases. A pacemaker was implanted in 7 out of 8 asymptomatic patients. Ventricular asystole of 3 seconds or more is proposed as a definite indication for the implantation of a permanent pacemaker.