On a syndrome of immunopathic type with pleural and systemic localization observed in patients with intracavitary electrostimulators. Considerations on 4 cases

: The complications arising out of the installation of pacemakers are listed and classified and it is suggested that a syndrome characterized by recurrent pleural effusion recalcitrant to the usual medico-depletive therapies, observed in four patients with pacemakers, should be included among such complications. The clinical pictures of the syndrome is described in detail and particular attention is paid to its date of onset in relation to installation of the pacemaker, early symptomatology, the most typical symptoms, clinico-humoral development, prognosis and therapy. Some theoretical and practical remarks are also offered, specifically three pathogenetic suggestions are formulated on the basis of clinical and developmental features but mainly in relation to humoral and immunological findings. These suggestions stress alternative interpretations of the syndrome: A) as an autoimmune disease arising secondary to surgical denaturation of myocardial and/or endocardial autoantigens; B) as a systemic autoimmune disease due to congenital or acquired insufficiency of immunological homeostasis; C) as a monosymptomatic pleural form of systemic lupus erythematodes with late clinical outbreak. The fascinating pathogenetic, clinical, biological and therapeutic resemblances between the present syndrome and the post-infarctual syndrome of Dressler and Johnson's post-pericardiotomic syndrome are pointed out and it is suggested that complications of medical nature already described as being secondary to the installation of pacemakers, such as endocarditis and pericarditis, should be looked at from an autoimmune type of pathogenetic viewpoint. Finally, in the light of personal observations, the need for immunological study of high risk patients, namely relations of patients with autoimmune diseases, is stressed. All candidates for pacemaker installation should also be included. Routine screening of this type would take on enormous practical importance as it would enable preventive or curative treatment to be undertaken to modify the immunitary balance of those subjects in whom pacemaker installation is liable to trigger off critical, irreversible breakdown in immunitary homoeostasis of which the syndrome in question would seem to be the most dramatic, but perhaps no the only, clinical manifestation.