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Heart sounds in patients with cardiac pacemakers.

Implantable transvenous endocardial pacemakers in patients with complete heart block have introduced a host of interesting auscultatory findings into clinical medicine. Some of these, such as variable intensity of first heart sound, were the consequences of the basic conduction abnormality and thus unaffected by pacing, while others, such as “pacemaker heart sounds,” were the result of pacemaker insertion and thus iatrogenic. In either case, physicians who are to take care of an ever-increasing number of patients with intracardiac pacemakers should be familiar with these different auscultatory phenomena.