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Pacemakers Celebrate Their 50th Birthday This Year

By Jo Ann LeQuang

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Published: 24Jul2008
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It may be hard to believe, but the cardiac pacemaker is celebrating its 50th birthday this year.

If you're math impaired or need some cultural points of reference, pacemakers were first invented before I Love Lucy went into syndication and they were in fairly widespread use before Richard Nixon, Helmut Schmidt, or Chairman Mao came to power.

Of course, the earliest pacemakers were really nothing like the small, compact, mini-computers that are in use today. The first pacemakers were large devices that could only supply small amounts of electricity to help force the heart to beat in a regular rhythm.

While modern pacemakers can last six, eight, even ten years or more, one of the very first devices implanted in a Swedish heart patient named Arne Larsson lasted just one day before the batteries conked out and the device had to be replaced. Mr. Larsson not only persevered through repeated operations in the early 1950s when technology was very basic, he became a lifelong advocate of implantable cardiac devices.

In fact, you could say the pacemaker was made for him. Actually, there were efforts in various locations in the early 1950s to find a way to build a pacemaker. It was known that a little bit of electricity delivered to the heart would force it to beat. It was also known that many people suffered from hearts that did not beat rapidly enough or reliably enough on their own. Over in Sweden, Arne Larsson had this condition and his wife worked tirelessly with an inventor to come up with an implantable device that would help him. Rvne Elmqvist was the inventor and the story goes that this first pacemaker was literally built in his kitchen.

Meanwhile, over in the United States, similar efforts were going on. A man by the name of Earl Bakken was also building a pacemaker based on plans he got out of Popular Mechanics for a metronome. The relationship between timing and pacing is important. Pacemakers not only have to give off electrical energy to help force the heart to beat, they have to do it in a precisely timed way. Pacemakers require precise timing circuitry to force the heart to beat in a healthful way.

The first big advancement in pacing came when pacemakers learned to do more than just pace the heart. Sensing is the function that allowed pacemakers to "listen" to the heart and literally record what the heart was doing on its own.

More sophisticated microchip technology gave pacemakers the "brains" so that after listening to the heart, it could decide if and when to pace.A pacemaker today literally listens to the patient's heart and "fills in the missing beats" as needed. When nothing is needed, the pacemaker merely observes, content to be on stand-by.

Another major advancement in pacemakers occurred with the so-called transvenous lead. Transvenous means "through the vein," and lead is the standard term for the insulated wire that runs from the pacemaker (usually implanted in the upper chest) to the heart itself.

The first pacemakers required an open-heart procedure to implant the pacemaker, but it was not to put in the pacemaker itself. That part of the operation can actually be done under local anesthetic. The reason an open-heart surgery was required back then was that the lead had to somehow be connected to the heart.

In the first generations of pacemakers, the lead was sewn to the outside of the heart. This made pacemaker surgery a major operation and left a big scar.

A transvenous lead was designed to be inserted through a tiny incision in a vein (so tiny it can be done under local anesthetic) and then gently maneuvered into the heart and anchored on the inside of the heart.

With transvenous leads, pacemaker surgery became much faster and simpler. In fact, for many patients (depending on individual factors), pacemaker implantation can be done on an outpatient basis.

Today, pacemakers are getting smaller, smarter, and lasting longer. Today's pacemakers keep a beat-by-beat record of the heart's activity (which it can send to the doctor's office in the form of a printout with graphs and tables). They can be programmed to help work around certain cardiac conditions to provide even better therapy.

The latest advancement involves what is being called "remote patient monitoring" or telemedicine. Using special equipment, a pacemaker patient can send information from the pacemaker to the doctor's office—from just about anywhere.

While remote patient monitoring is becoming increasingly sophisticated, pacemakers were actually some of the original devices to offer telemedicine. Even as far back as the 1980s, pacemaker people could send information from home to the doctor's office over a regular telephone. That technology is still around today, although with some refinements. In fact, pacemakers were some of the very first devices to introduce the whole concept of having a "check-up" with doctor and patient in two different locations!

The pacemaker business is still going strong. Millions of people all over the world have benefited and continue to benefit from this life-enhancing therapy.

While finding out you need a pacemaker can be a big surprise and quite unsettling, most long-term pacemaker patients adjust well to having the device. Some even report that they more or less forget about it between check-ups.

Most pacemaker patients are older individuals (50 and above) but pacemakers are sometimes used in children and even newborns.Pacemakers are literally implanted in newborns one day old and in centenarians.

If you or a loved one has a pacemaker, you should know that in the past 50 years a lot of myths have surrounded them. Can you use a microwave oven? What things might interfere with your pacemaker (some of these will SURPRISE you)? What is surgery like? Get the answers to these and other pacemaker questions by clicking http://www.pacemaker411.com . This article was written by Jo Ann LeQuang.

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