Talk:Artificial cardiac pacemaker

Timeline

I'm trying to create a timeline for the history of artificial pacemakers:

1954 - First cardiac pacemaker stimulates a human heart - Used skin electrodes, caused skin burns.

1955 - Dr. Paul Zoll, MD, developed a pulse generator that stimulates the heart. Manufactured as the PM-65 by Electrodyne, it was intended for use as emergency support during cardiac surgery.

1957 - After a power outage caused a PM-65 to stop functioning, Dr. C. Walton Lillehei asked Earl Bakken to create a device that worked on batteries. This prototype lead to the 5800 line of pacemakers by Medtronic, the first wearable external pacemaker. This device was also the first with implantable internal electrodes.

1958/Oct/8 - Under the direction of Dr. Åke Senning, Rune Elmqvist developed the first fully implantable pacemaker. The first implantation was performed on a Swedish man named Arne Larsson. He was 43 y/o at the time, and suffered from life-threatening Stokes-Adams seizures. (The first device worked for three hours. A second one was inserted the next day, which worked for a couple of weeks. In 1971 Mr. Larsson got a device that worked well. Mr. Larsson lived a long and full life until his death on December 28, 2001. Over his lifetime, Mr. Larsson received a total of 22 pacemakers over 43 years.) The power supply for this first pacemaker was two nickel cadmium battery cells which were recharged from the outside by an inductive coil. The battery cells and the silicon transistors were encased in epoxy resin. The entire pacemaker device (excluding leads) measured 55mm diameter by 16mm thickness.

1959/May/19 - First long term transvenous pacing wire used. A 67 year old male with high degree heart block underwent insertion of a transvenous lead via cephalic vein cut down. The transvenous wire was attached to an externalized pacing system via the skin incision. The pacing system was able to sense native ventricular activity, but was not able to inhibit pacing output based on sensed activity. The gentleman was discharged from the hospital on June 23, 1959. Because the pacing lead exited through the skin, the skin site required frequently infected. However he never developed a systemic infection due to the pacing system. After using the device for 41 months, he underwent implantation of a completely internal pacemaker system on November 8, 1962. He died 20 days later due to complications from the surgery.

1959 - Dr. William Chardack and Dr. Andrew Gage at the Veterans Administration Hospital in Buffalo, N.Y., working with William Greatbatch (an electrical engineer), developed the (first) a fully implantable pacemaker using primary cells as a power source.

1960/Feb/3 - Orestes Fiandra MD and Roberto Rubio MD implanted the first pacemaker in the Western Hemisphere in a 40 year old woman with complete heart block and syncopal episodes. The device worked for the 9 months that the patient survived her other ailments. The device was designed in cooperation with, and produced by, Rune Elmqvist.

1960/Jun/6 - Chardack, Gage and Greatbatch implanted a self-contained, completely internal pacemaker powered by a non-rechargeable mercury zinc oxide batteries, in Buffalo, USA. The patient died 2 years later of unrelated causes.

1960/Jul - Greatbatch files for a patent on the implantable pacemaker. It is granted(!)in 1962.

1960 - Medtronic creates (first)a long-term implantable pacemaker system

1962 - The first permanent transvenous pacemakers were implanted almost simultaneously by Lagergren in Sweden and Parsonnet in New Jersey. (Parsonnet, V., Zucker, I.R., and Asa, M.M.: Preliminary Investigation of the development of a permanent implantable pacemaker utilizing an intracardiac dipolar electrode. Clin. Res., 10: 391, 1962. Parsonnet, V. Permanent Transvenous pacing in 1962. Pace, 1: 285, 1978. Lagergren, H and Johansson, L. Intracardiac stimulation for complete heart block. Acta. Chir. Scan. 125:562, 1963; Lagergren, H. "How it Happened: My Recollection of Early Pacing." PACE: Pacing and Clinical Electrophysiology 1.1 (Janurary 1978): 140-43., )

1974/Jul/9 - Cardiac Pacemkers, Inc. (Guidant) creates first pacemaker with lithium battery : REF: *PT#: 3822707 Metal-Enclosed Cardiac Pacer with Solid-State Power Source - Image Document

1974 - Plutonium battery devices in use.

References:

http://www.mnhs.org/collections/medTech/org_cardiac_pacemakers.html

http://www.naspe.org/ep-history/timeline/

http://www.medtronic.com/corporate/history.html

http://www.bae.ncsu.edu/bae/courses/bae465/1995_projects/scho/htmls/history1.html

http://inventors.about.com/library/inventors/blcardiac.htm

---

How about this one?

• History of Pacemakers

--Smithfarm 15:04, 14 August 2006 (UTC)

Article name

Isn't "artificial pacemaker" redundant? Shouldn't this article be at Heart pacemaker or something like that? RickK | Talk 02:50, 6 Apr 2004 (UTC)

The first sentence covers that. The heart contains natural pacemaker cells, described at Cardiac pacemaker. -- Cyrius|&#9998 03:28, Apr 6, 2004 (UTC)

There is some "first"-words that can be removed when discussing Greatbatch. I have put them in parenthesis above. This as the swedish device was really the first to be implanted, and that the Uruguay one was the first long-live one. I also added some details about the Swedish devices. The development of these devices continued, and pacemakers are still being produced and developed in Sweden, now under the name of St. Jude Medical Inc. One of their products is the worlds smallest pacemaker.

Ake Senning and Rune Elmqvist did present their pacemaker design on the second international conference on medical electronics in Paris in june 1959. The title of their abstract is "An implantable pacemaker for the hearth."

I agree that "artificial pacemaker" is a bizarre title for this article. How about moving the article to "implantable pacemaker"? No one in medicine uses the name "artificial pacemaker" when talking about the implantable device. MoodyGroove 18:09, 25 January 2007 (UTC)MoodyGroove

I get it now. The article includes external pacing and transvenous pacing. I looked up pacing in a book I have called the History of Cardiology and it does make reference to the "artificial pacemaker." Perhaps implantable pacemaker should be a separate article, and include the NBG pacemaker code. MoodyGroove 01:32, 26 January 2007 (UTC)MoodyGroove

If you look at the edit history you will find that it started out as an article about implantable pacemakers, but have since grown. Maybe a split may be a good idea? Mossig 12:25, 27 January 2007 (UTC)

I agree with that. There's already an article for transcutaneous pacing. I didn't find one for transvenous pacing. Implantable pacemaker, in my opinion, is an important enough topic that it deserves a dedicated article. As for biventricular pacing, it could either be a part of the implantable pacemaker article, or be separate. I see no particular reason to merge it, since there have been so many important studies dedicated to the use of resynchronization therapy for heart failure. It comes down to article size once these topics are fully expanded. MoodyGroove 14:30, 27 January 2007 (UTC)MoodyGroove

Perhaps better name artificial cardiac pacemaker? There are multiple entries for pacemaker. Dlodge 20:19, 2 November 2007 (UTC)

What about "Pacemaker (artificial)"? -Rolypolyman (talk) 12:52, 13 March 2008 (UTC)

How about Cardiac pacemaker (artificial)? Dlodge (talk) 17:40, 13 March 2008 (UTC)

I think 'implantable cardiac pacemaker' is appropriate and all encompassing —Preceding unsigned comment added by 193.61.118.252 (talk) 16:14, 28 March 2008 (UTC)

I'm in agreement with Pacemaker (artificial). MoodyGroove (talk) 20:55, 28 March 2008 (UTC)MoodyGroove

Power consumption

What's the typical power consumption of an artificial pacemaker? 193.171.121.30 00:58, 13 May 2005 (UTC)

A modern pacemaker (2006) utilises a lithium anode cell as it's energy source, most commonly a lithium-iodide combination lithium battery and in sensing mode draws a current of ~ 10 microampere. In pacing mode the current draw is typically 25 microampere, under which condition the 'power consumption' will be (2.8) x (25 to the power minus 6)Geoffrey Wickham 02:22, 21 December 2006 (UTC)

Possible copyvio?

The text at the end of the page seems to be copied directly from the middle part of [1], ?s and all (before I corrected the ?s into 's anyway). However, it also appears in some other pages in the google cache, such as [2] (currently 404'd at the original url) The text was added in [3] by 144.15.16.71, which has no other contributions. Should this be removed, or has authorization for the use of this text been given at some time in the past? -- bd_ 00:17, 25 Feb 2005 (UTC)

• I removed it. Osmodiar 06:56, 3 Apr 2005 (UTC)

It looks like this article is almost identical to one found here: http://www.thedoctorslounge.net/cardiology/procedures/pacemaker.htm. Doctor's lounge says it is copyrighted... question is who copied from whom? Nephron 06:21, 21 March 2006 (UTC)

Why did you remove the whole article? Large parts of the wikipedia article is not the same as the linked one. And still no indication of who has copied who. If you look at the history of the page, you can see the evolution of the article. (And I have made parts of the contrubution myself.)Please reinstate immediatly. I think that these kind of actions is the same as vandalism. 09:45, 21 March 2006 (UTC)

Avoiding pacemaker rejection

Discussion copied from Wikipedia:Reference desk/Science. Jay 11:44, 10 February 2006 (UTC)

What is done to $e2+c2=d2$avoid the body's immune system treating an artificial pacemaker as a foreign body and creating anti-bodies to reject it ? Jay 08:03, 2 February 2006 (UTC)

Immunosuppressive drugs are the most common technique. -- Daverocks (talk) 10:05, 2 February 2006 (UTC)

I actually had checked out the Immunosuppressive drug article. It talked of natural organ translpants, but there was no mention of artificial organ transplants. Will the case with artifical be a lot different ? Jay 12:48, 2 February 2006 (UTC)

The chemical makeup of the casing is so designed that it will rarely cause problems. The whole thing will not be rejected, and will be encapsulated by scar tissue, in the same way a piercing is. -- Ec5618 11:21, 2 February 2006 (UTC)

Can you give some link to this ? I would like to add all this to the article. Jay 12:48, 2 February 2006 (UTC)

Immunosuppressive drugs are not used when mechanical devices (or even non-living biomechanical devices such as a porcine heart valve) are implanted. Such devices do not provoke a Type IV hypersensitivy immunological response. - Nunh-huh 20:02, 2 February 2006 (UTC)

Oh. Whoops. I guess I shouldn't talk from now on, considering I'm not a physicist physician. Must stop getting my words mixed up. -- Daverocks (talk) 06:11, 3 February 2006 (UTC)

The outser casing of pacemakers is often (usually?) made of titanium, which is very inert in the body. It is also used for joint replacements and some dental prostheses, for the same reason. Physchim62 (talk) 20:55, 2 February 2006 (UTC)

seems to be jacked

http://www.reference.com/browse/wiki/Artificial_pacemaker

--Jaysscholar 18:57, 19 February 2006 (UTC)

The above is alright. At the bottom of the page it says:

Source: Wikipedia, the free encyclopedia © 2001-2006 Wikipedia contributors (Disclaimer)

This article is licensed under the GNU Free Documentation License.

I'm not sure I can say the same about http://www.thedoctorslounge.net/cardiology/procedures/pacemaker.htm. Nephron 06:26, 21 March 2006 (UTC)

• Can someone check on the Wayback machine to see what it shows for the doctors lounge page? If not, I'll do it in about 10 hours when I get home. The work proxies block access to wayback, and it's not worth it for me to go around them for this. Wikibofh_(talk) 14:12, 21 March 2006 (UTC)

• My guess is that the copyvio goes the other way, but I can't prove it. For this stuff the earliest I can find the article on thedoctorslounge is May 18th, 2004. The text in question is added to the article on January 9, 2003. I would argue it likely is NOT a copyvio. Wikibofh_(talk) 22:50, 21 March 2006 (UTC)

I was unable to find anything on the wayback machine, but maybe I didn't use it correctly. By reviewing the edit history for this article, its pretty clear that much of the basic structure of the WP article dates back to 2003 and approaches its current form fairly well by 2004. As best as I can tell, the doctors-lounge article was copied from WP in summer 2004. I'm using the opening sentence of the third paragraph as evidence:

The first pacemakers required wires (called leads) to be placed surgically on the

which is added on 5 April 2004 by User:Ksheka [4], but is modified into its current form on 28 December 2004 in a large edit by anon User:144.15.16.71 [5]. .

Meanwhile, the 5 April 2004 version of the WP article ends its opening paragraph with

Generally, pacemakers do not treat fast rhythms of the heart.

which is absent from the doctorslounge article. This sentance was removed from WP on 19 September 2005 by User:202.156.2.147 in this edit: [6] The doctorlounge article seems to have been copied from WP between april and december 2004, but subsequently edited to track the newer intro paragraphs that WP has. This seems to indicate that the doctorslounge article is not just a one-time copy from WP, but is repeatedly edited to track WP. linas 03:30, 22 March 2006 (UTC)

• I did manage to use the wayback machine (once at home) which is where I got my dates. I've commented on the copyvio page. Given all of this, I'm going to revert to the pre-copyvio version. Wikibofh_(talk) 03:43, 22 March 2006 (UTC)

Interesting research. Is there someone that will write a friendly email to Doctor's Lounge about this? Awaiting curiously to see how this will develop, Nephron 04:01, 22 March 2006 (UTC)

• • Normally this happens via mirrors and forks, for what it's worth. I don't really care to do it though.  :) Wikibofh_(talk) 04:40, 22 March 2006 (UTC)

Nuclear power?

The first American-made nuclear-powered pacemaker was developed and implanted by ...

From this sentence I get the idea that pacemakers do not use ordinary batteries, but instead some kind of nuclear power. However the article has precious little to say about it. Anyone care to expand on this? --Smithfarm 14:51, 14 August 2006 (UTC)

At least one form of isotope powered pacemaker was produced in limited quantities in ca 1968-9 by US company "ARCO" as an alternative to the unreliable mercuric oxide - zinc battery in general use at that time. The development by Wilson Greatbatch of the lithium - iodide cell lithium battery commencing 1970 offered the probability of the required energy density and reliability necessary without the the potential hazards of isotopic based energy sources. Lithium anode cells became the system of choice by the mid 70'. Geoffrey Wickham02:39, 21 December 2006 (UTC)

Bigelow reference

I have deleted the singular reference to Dr Bigelow and added relevant synoptic text to John Hopps. Dr's Bigelow & Callaghan at Toronto General Hospital in 1950 noted during open heart surgery that heartbeats could be elicited by 'prodding' the exposed non-beating heart and from this postulated that electrical stimulation might produce a similar effect. Their postulate was presented to John Hopps. Reference: www.utoronto.ca/bantresf/HallofFame/Bigelow.html. An article referring to the many contributions to open heart surgey by Dr. Wilfred Bigelow would be appropriate.Geoffrey Wickham 03:42, 21 December 2006 (UTC)

Hyman pacemaker

A supporting & informative link to the Hyman Pacemaker is at http://www.hrsonline.org/ep-history/topics_in_depth/topics/hymanpacemaker.asp , which can also be found by doing a Google "hyman pacemaker". Would someone with more knowledge of Wikipedia procedures please put-in a link where is requested ?Geoffrey Wickham 03:50, 30 December 2006 (UTC)

Article Cardiac resynchronization therapy

The above article is tagged with a proposal it be merged with Artificial pacemaker section Artificial_pacemaker#Bi-Ventricular pacing (BVP). The latter section is also tagged suggesting merging with Cardiac resynchronization therapy.As the information provided in Cardiac resynchronization therapy duplicates that in Artificial pacemaker and as Artificial pacemaker is the definitive article, I suggest that it would best to tag Cardiac resynchronization therapy for deletion. What do others think ?Geoffrey Wickham 02:19, 1 January 2007 (UTC)

I think that properly expanded, it has stand-alone merit. Eventually it will need to be a separate article. Best, MoodyGroove 18:49, 22 February 2007 (UTC)MoodyGroove

• I am Opposed to merging Cardiac resynchronization therapy into the current article. Once this article is fully expanded, it will easily meet the recommended size limit. It should touch on cardiac resynchronization therapy and refer the reader to the other article for a more detailed discussion of the indications, lead placement techniques, and relevant clinical trials. Best, MoodyGroove 15:10, 27 February 2007 (UTC)MoodyGroove

J A McWilliam

My edit of 5.23 25 January 2007. Reference is McWilliam J.A., Brit Med. J. 1889, 1:348-350, referenced in http://hrsonline.org/ep-history/timeline/1800s/ . Would a user more competant in Wikipedia formatting please enter the reference in the article's references. Thanks Geoffrey Wickham 05:33, 25 January 2007 (UTC)

• done. Gnusmas 08:15, 31 January 2007 (UTC)

Reference to pervenous pacing in History

My edit of 07.28 31 January 2007. The reference for is http://www.hrsonline.org/ep-history/notable_figures/bios/jean-jacques_welti/. Would a user more competant in Wikipedia formatting please enter the reference in the article's references. Thanks Geoffrey Wickham 07:41, 31 January 2007 (UTC)

• done. Gnusmas 08:15, 31 January 2007 (UTC)

Reference to Lidwell in pacing history

Re my edit of 05.05 7 February 2007; would a user more competant in formatting please enter at 'citation needed' the link http://www.sahha.gov.mt/pages.aspx?page=665 .Geoffrey Wickham 05:15, 7 February 2007 (UTC)

Deletion of ref. to Brain Pacemaker

The term "Brain Pacemaker" is an inaccurate journalistic term, not clinical terminology. A "pacemaker", as in cardiac pacemaker, is a device which applies a singular electrical impulse by way of one electrode contacting the heart muscle in order to evoke a single muscular contraction, or may apply singular or grouped impulses to 2 or more electrodes in order to terminate a cardiac arrhythmia. A "brain pacemaker" does not use a singular electrical impulse to evoke an immediate contraction, or singular response by the brain; instead it appplies a train of impulses at a frequency upwards of 80Hz, to block or change the manner in which chemical synapse's operate in groups or in communication between groups and thus acts in the manner of a chemical drug but with more focus than a drug. Thus, I argue that reference to "Brain Pacemaker" within the top section of Artificial Pacemaker is incorrect and misleading to the lay reader.Geoffrey Wickham 03:25, 20 February 2007 (UTC)

Pacemaker history

Robert Fischell and the Applied Physics Laboratory at Johns Hopkins contributed to significant advances in pacemaker technology including the rechargeable pacemaker (Pacesetter Systems, Inc.) and using radiowaves for telemetry.[7] Best, MoodyGroove 03:30, 22 February 2007 (UTC)MoodyGroove

Not to rain on anybodies parade, but the worlds first implantable pacemaker was rechargable. And we need a better reference in order to judge if Medtronic was the first to use telemetry in order to communicate with pacemakers. Mossig 12:48, 22 February 2007 (UTC)

• Who said anything about Medtronic? Am I to understand that the Applied Physics Laboratory at Johns Hopkins isn't a reliable source? Just curious, what would you accept as a reference? Best, MoodyGroove 14:17, 22 February 2007 (UTC)MoodyGroove

I didn't intend to attack the credibility of the article. I could not find any reference to this being the first use of wireless reprogrammong of a pacemkaer. But I will have a second look in my notes on the subject. I will come back to you on this subject. Mossig 17:54, 22 February 2007 (UTC)

I'd be interested in seeing any and all evidence on the topic. I'm here to learn as well as edit. MoodyGroove 18:12, 22 February 2007 (UTC)MoodyGroove

What I find is from Schoenfeld, "Pacemaker Programmers: An Updated Synopsis": "...in 1973 [10] the ability to effect stable and lasting alterations in programmed parameters was achieved via an external electromagnetic programmer emitting a pulsed magnetic field that would open or close a pacer’s reed switch. Radiofrequency waves were~rst utilized for programming in the late 1970s." Mossig 10:45, 23 February 2007 (UTC)

I remember hearing something about the magnetic reed switch. Even that is quite fascinating. It sounds to me like there's an excellent chance that the Fischell team at Hopkins was the first to use radiowaves for programming and telemetry (by applying satellite technology to implantable devices). I'll do more searching and see if anyone else makes the claim. MoodyGroove 13:25, 23 February 2007 (UTC)MoodyGroove

• Also, could you please provide a reference for the first implantable pacemaker being rechargeable? Thanks. MoodyGroove 14:20, 22 February 2007 (UTC)MoodyGroove

The most obvious is the Wikipedia article as it stands today. Another one is http://hrsonline.org/ep-history/timeline/1950s/#first. Mossig 17:54, 22 February 2007 (UTC)

The Wikipedia article itself is not relevant, since it's a dynamic source that stands or falls by verifiability. But the article from the Heart Rhythm Society webpage is interesting. It's strange that other sources credit Fischell and other inventors in the late 60s, early 70s with inventing the rechargeable pacemaker. Perhaps what they mean is "rechargeable in a practical sense." I did find a PubMed citation on the Fischell pacemaker. Love JW, Lewis KB, Fischell RE, "The Johns Hopkins rechargeable pacemaker. Historical aspect." JAMA 1975 Oct 6;234(1):64-6. MoodyGroove 18:12, 22 February 2007 (UTC)MoodyGroove

My sad experience is that articles about inventors and the claims in them often are very biased (and sometimes flat out wrong). One typical way of twisting history is the use of "practical" and similar soft words. One example is all the articles and webpages which names W. Greatbatch as the inventor of the implantable pacemaker. An example from another field is teh museum at Kennedy Space Center: all exhibits are either "the worlds first" or "the first american". And all of the exhibits are of american spacecrafts. The choise between the two fists clearly follows a political agenda in that case. Mossig 10:45, 23 February 2007 (UTC)

Noted. For the record, I wrote a significant portion of the Robert Fischell article, and I've done my best to base it on verifiable references. I don't know the man, but I'm impressed with the scope of his achievements. It seems to me that a new design or improvement that makes a technology practical for clinical use can be a break-through moment. The key is presenting the invention in its appropriate context. The Johns Hopkins Rechargeable Pacemaker was supplanted relatively quickly by the advanced lithium battery, but it seems to me the Applied Physics Laboratory at Johns Hopkins deserves to be mentioned somewhere in the article. I'm going to try to get a full text version of the JAMA (1975) article and see if I can gain a better appreciation for what happened during the short time frame that 6000 of the devices were implanted in humans. I'll let you know if I find anything interesting. MoodyGroove 13:25, 23 February 2007 (UTC)MoodyGroove

• Here is the expanded reference I provided for any other editor who wants to take a look: Fischell R. (1998), "Applications of Transit Satellite Technology to Biomedical Devices," Johns Hopkins APL Technical Digest; Vol 19, No. 1.
• Here's another reference: Wagner GD (1999), "History of Electronic Packaging at APL: From the VT Fuse to the NEAR Spacecraft," Johns Hopkins APL Technical Digest, pp. 18-19, Vol. 20, No. 1. MoodyGroove 14:38, 22 February 2007 (UTC)MoodyGroove
• And another: Neal E. (2003), "Technology for Humanity: Robert Fischell," Discover, Vol. 24, No. 11. "His career as a medical inventor was launched the day he spotted an advertisement for pacemakers with batteries that had to be replaced every two years. He told a cardiologist friend at Hopkins that he could build a smaller unit, one that would run, as satellites did then, on a rechargeable nickel-cadmium battery that could last almost indefinitely. Three days later, he and his colleagues at the lab had built an effective prototype that changed the way pacemakers were built." MoodyGroove 14:38, 22 February 2007 (UTC)MoodyGroove

I am a bit sceptical about the last claim of the cited text, as I do not know of any modern pacemakers that uses rechargable batteries, This is due to the risks of forgetting to charge the implant, and the psychological strain the need of recharging places on the patient. Mossig 17:56, 22 February 2007 (UTC)

The first reference acknowledges that the advanced lithium battery made the rechargeable pacemaker obsolete. In the meantime, 6000 rechargeable pacemakers were implanted in humans. It just seemed it me that in a period of rapid technological advances in pacemaker technology, it was something worth mentioning. Since other editors have taken on the pacemaker history section as a pet project, I thought I'd post the information here for consideration. MoodyGroove 18:03, 22 February 2007 (UTC)MoodyGroove

• Here's a new reference I found for the Hopkins Rechargeable Pacemaker: Meadows, P., "Technology Transfer and Successful Electrical Stimulation Business," Advanced Bionics Corporation, p. 2. "One of Mr. Mann’s early customers was the Applied Physics Laboratory (APL) at Johns Hopkins University. APL was trying to utilize some of its advanced technology and engineering to advance the state of the art in medical devices. One project was to create a pacemaker that would last longer than the 18 to 21 months that was typical at the time and proposed to make a rechargeable device. Spectrolab/Heliotek were primary sources for space power systems so it was natural for APL to seek out Mr. Mann. The eventual result was the formation of a new company, Pacesetter Systems. The initial technology transfer was important to the development of this product, but key to its success were the additional technological advancements that were offered in their first product: not only would it last for many years, but it was smaller than any other. It was the first device with telemetry, it was hermetically sealed, and it was the first pacemaker system to be essentially immune to electronic interference, such as microwaves. The first rechargeable pacemaker was implanted in 1973 and the first patient lived with that device for over 12 years. Today there are over 1000 patients with these systems, some with over 24 years of operation. The later advent of lithium iodine batteries would change the market, but Pacesetter became widely acknowledged as building the most reliable and most technically advanced products on the market." MoodyGroove 18:23, 23 February 2007 (UTC)MoodyGroove

• "Programmable Pacemaker," Spinoff (Publication of NASA featuring commercial applicatons of space technology), 1996. "In the latter 1970s, Pacesetter brought to the commercial market three significant advances based on the NASA/APL/Pacesetter collaborations: the first rechargeable, long-life pacemaker battery, based on technology for spacecraft electrical power systems; the first single-chip pacemaker, a product of space microminiaturization technology that allowed a substantial reduction in the size of implantable pulse generators; and the first pacing system to utilize bidirectional telemetry, the NASA-developed technology for two-way communication with satellites that provided a way for physicians to communicate with an implanted pacemaker and reprogram it without surgery." MoodyGroove 18:40, 23 February 2007 (UTC)MoodyGroove

Hello to MoodyGroove and Mossig with compliments on your contributions and WP:Civil manners. It may be helpful to put forward some of my memories of pacemaker history. In relation to rechargeable pacemakers, and ignoring the pioneering 1958 work in Sweden, the first practical rechargeable device, using the NASA-developed sealed nickel-cadmium cell for it's battery, was in ca 1976 by Pacesetter Systems Inc. It was a bulky device, similar in volume to the early lithium-iodide devices which used the Greatbatch 702 cell in 1972-1974 and which were to demonstrate lifetimes of up to 15 years if the patient lived that long. But, by 1976 the lithium-iodide cell had been evolved to a much smaller size and with a projected lifetime of 5+ years met the clinical need for a pacemaker which was sufficiently long-lived for most patients, small enough to be implanted or replaced using local anaesthesia, and which did not require the regimen of recharging. Thus, the Pacesetter Systems device while certainly using the highest level of rechargeable battery technology was a case of too much too late, but none the less had quite high clinical acceptance with many thousands being implanted mainly in the USA. Going to the matter of external programming, the first innovations in 1964-65 used a simple 'two choice' arrangement where a magnetic reed switch was flip-flopped from outside the body by reversing a bar magnet. Then in ca 1976 the Cordis Corporation Inc followed with a system using using a reed switch in the implant which was pulsed from outside by a 300Hz magnetic field, allowing the first digital multi-parameter control. Pacesetter Systems Inc introduced the first RF (radio frequency) coupled programming system in ca 1982, using the work of Robert Fischell and, as I recall, co-operation of John Hopkins Uni; this was followed in ca 1985 using bidirectional telemetry by Pacesetter Systems and others. Bidirectional telemetry, with different manufacturers using different protocols, became the standard. Modern pacers also use non-volatile memories to allow examination of the patient's pacing/cardiac activity by RF coupled interrogation. It is very difficult to find verifiable published sources to support my memory, so if any reader can help it would be greatly appreciated. Kind regards to all. Geoffrey Wickham60.230.49.110 02:14, 25 February 2007 (UTC)

That's very helpful. I'm on duty tomorrow, but sometime in the next week I'll see if I can put together a paragraph or two for the article that is to everyone's liking (unless someone else would like to work on it in the meantime). After that, I'll probably set my attention to clinical indications and the NBG code. Best, MoodyGroove 03:44, 25 February 2007 (UTC)MoodyGroove

• "The Alfred Mann Foundation," Mission and History, "In about 1968, Al Mann made a donation to Johns Hopkins University Applied Physics Laboratory to further the development of a long lasting small cardiac pacemaker. In those days cardiac pacemakers weighed about a pound and were one inch thick making a large bulge on the chest, and needed to be surgically replaced approximately every 18 months. and in some instances every year. Many great research developments from universities often are released as a publication, but rarely are made into a product for the public. Al Mann wanted to make sure that this product was made available to the public, so he obtained the manufacturing rights to guarantee that it was made available to the public. In 1969 he hired Joe Schulman to take the technology from the Applied Physics Lab and set up a production line to manufacture commercial quantities of the pacemaker, and help develop new products. Four years and two major design changes later, and the first commercial rechargeable cardiac pacemaker was implanted in 1973, and Pacesetter Systems Inc. was born. The company developed the first pacemaker with two-way telemetry." MoodyGroove 19:35, 25 February 2007 (UTC)MoodyGroove

Comment on above re date of first implant of Pacesetter. 1973 would probably be right for the "first" as it generally took about 2 years to get past the FDA. The "weighed about a pound" statement is very wrong. Typically for that era the implant weighed 90-110 gms (a bit over 3 oz)Geoffrey Wickham 21:50, 25 February 2007 (UTC)

• Furman S., The early history of cardiac pacing. Pacing Clin Electrophysiol; 2003:26(10):2023-32. PMID: 14516345. "The earliest models of the pacemaker manufactured by General Electric Co. during 1961 contained a bistable magnet switch. Magnet movement of the switch in one direction produced an asynchronous stimulation rate of 70 beats/min, in the opposite direction, 100 beats/min, one rate for rest and the other for activity, with the rate selected at the patient's discretion. The value of this capability was not appreciated at the time and not duplicated by other manufacturers. In 1972 Medtronic Inc. introduced a technique of varying the output pulse duration at a fixed output voltage, to change the output per stimulus. Variation was accomplished by noninvasively rotating a gear train within the implanted pulse generator. This gear train was attached to small bar magnets. The programmer was an external device in which similar, but much larger, bar magnets were manaully rotated. The external magnets attracted and caused the rotation of the magnets and thus the gear train within the implanted pulse generator. An asynchronous (model 5931) and a ventricular inhibited generator (model 5961) were available. Both were nonhermetic but metal clad to resist electromagnetic interference. During 1972 the Cordis Corp. introduced a noninvasive true programming system in which the external programmer introduced a rapid magnetic pulse train in which the duration of the train was different for each setting to be programmed. Within the hermetically sealed implanted digital circuit, a reed switch was opened and closed magnetically, and counted. The circuit settings were modified accordingly. Constant currnet output was programmable at four levels and rate at 5. Four different pulse generator models were available, asynchronous, ventricular inhibited, ventricular triggered, and atrial synchronous. A year later Medtronic introduced a radiofrequency programming technique which varied the rate only, in six steps. The programmer contained a magnet which when placed over the pulse generator closed a magnetic switch within in the pulse generator, allowing it to receive the radiofrequency signals transmitted from the programmer. Other manufacturers soon introduced other programming systems making pacemaker programming a standard feature in a wide variety of pulse generators."

• Comment: What do you make of this, GW? MoodyGroove 01:47, 26 February 2007 (UTC)MoodyGroove

• . Roger MG. Sy Furman is held in high regard both for his work in the early years and for his endevours in the last couple of decades in creating a record of pacemaker history by way initially of NASPE & then the Cardiac Rhythm Society, so anything published by Sy surely meets the Wikipedia criterion for verifiability of edits. If an editor wishes to go further it is often useful to check the publication to see whether statements made in it are verified by cited references; and to keep searching for other sources. Back issues of the Journal you cite are available at the Uni Melbourne so I'll make a point of having a look when next in Melbourne. I could make some comments about possible inaccuracies in the Furman article, but because they would come from memory it would be unwise. I think we both have a common objective of providing the Wikipedia pacemaker history with an accurate synoptic history so let's keep at it and keep in contact. All the bestGeoffrey Wickham 60.230.49.110 03:47, 27 February 2007 (UTC) (sign-in dropped out again)

Thanks, GW. This reference seems to imply that Medtronic was the first to use RF signals for telemetry, although it looks like both the Medtronic device and the Hopkins/Pacesetter device had RF telemetry in 1973. Can you think of a way to confirm the exact dates? The other references claim that Hopkins/Pacesetter was the first to utilize bidirectional telemetry (I am guessing that means the ability to receive information from the implanted device about pacing parameters and battery strength). Does that sound reasonable? By all means, let's keep at it! Best, MoodyGroove 13:31, 27 February 2007 (UTC)MoodyGroove

• If possible I would like to put this paragraph into a format that matches the rest of the section (i.e., explain the exact contribution(s) and the date). Perhaps a wiki-table is something we could look at for the timeline.

Others who contributed significantly to the technological development of the pacemaker in the pioneering years were Bob Anderson of Medtronic Minneapolis, Geoffrey Davies of Devices Ltd in England, Barouh Berkovits and Sheldon Thaler of American Optical, Geoffrey Wickham of Telectronics Australia, Walter Keller of Cordis Corp. of Miami, Hans Thornander who joined previously mentioned Rune Elmquist of Elema-Schonander in Sweden, Janwillem van den Berg of Holland and Manuel A. Villafaña and Anthony Adducci of Cardiac Pacemakers Inc.(Guidant) Best, MoodyGroove 20:17, 27 February 2007 (UTC)MoodyGroove

• Here is some new information for the request of dates and exact contibutions above:
• In July 9th of 1974, Manuel A. Villafaña and Anthony Adducci founders of Cardiac Pacemakers Inc.(Guidant) in St. Paul Minneosta, manufactured the worlds first pacemaker with a lithium anode and a lithium-iodide electrolyte solid-state battery. ( SOURCE: http://www.google.com/patents?vid=USPAT3822707&id=KVEvAAAAEBAJ&dq=3822707&jtp=1 and http://www.mnhs.org/collections/medTech/bio_adducci.html )

• MG. Message on your talk pageGeoffrey Wickham 01:46, 1 March 2007 (UTC)

Request for comment

Greetings, apologies for this slight diversion, but there is confusion on another page about whether cardiac implants use power transmission via electrical induction or conduction or both. It would be great if you could make a comment over at this link Talk:Wireless_energy_transfer#Cardiac_energy_transfer_through_tissue. Thanks and best regards.Charles 14:54, 25 February 2007 (UTC)

Hi Charles, Have commented on your talk pageGeoffrey Wickham 01:23, 26 February 2007 (UTC)

Cost for one of theses beauties

I was wondering whether anyone knew of the price listing on these shiny pieces of humans are? A listing of them in any currency from where the information is available is good I guess. Thanksly, Aeryck89 04:08, 29 March 2007 (UTC)

Link Problems

The links to references 1, 2, 5 no longer work (at least not for me). However, the home page for each of these 3 links still works. It's http://www.hrsonline.org ; but one has to navigate from there to find the references. Does anybody more computer savvy than me have any good ideas ? Geoffrey Wickham 02:46, 10 May 2007 (UTC)

If you could navigate to the appropriate web pages that correspond to each reference and share the URL for each on my talk page, I will be happy to turn them into in-line citations. Best, MoodyGroove 15:25, 10 May 2007 (UTC)MoodyGroove

Thanks. I've inserted ref 4 (Mond) to the Hyman section as Mond also discusses the Hyman pacemaker. Geoffrey Wickham 22:45, 11 May 2007 (UTC) NO, didn't work. When I insert the Mond ref it brings-up ref 3.Geoffrey Wickham 03:16, 12 May 2007 (UTC)

Edit of 05.07 13 Oct 2007

A 'thank you' to user Vpace1 ( who doesn't have a home page) for supplying the additional references.Geoffrey Wickham 05:18, 13 October 2007 (UTC)

Peer review

Geoffrey Wickham (talk · contribs) asked for peer review. Firstly, congratulations on the hard work! With the infrequent appearance of our wiki-cardiologist some electrophysiology articles were suffering a bit, but not this one!

Some brief comments:

• I don't think bolding the years in the history section is consistent with the manual of style.
• Not all references to journal articles use the {{cite journal}} template, and lack PMID numbers.
• We need to mention the downsides of pacing ("pacing cardiomyopathy", which can be overcome with demand pacing etc), infection of leads, rate of complications, lead fracture etc etc.
• I wish to offer PMID 15530632 (Trohman RG, Kim MH, Pinski SL (2004). "Cardiac pacing: the state of the art". Lancet. 364 (9446): 1701–19. doi:10.1016/S0140-6736(04)17358-3. PMID 15530632.{{cite journal}}: CS1 maint: multiple names: authors list (link)) for consideration as a resource, mainly for some more clinical background.

Let me know if help is needed. I may be able to lend a hand. JFW | T@lk 19:48, 24 October 2007 (UTC)

Deletion of edit re Jorge Reynolds Pombo in History

An edit in History of 15.14, 4 December 2008 by 190.93.144.10 implies that Jorge Reynolds Pombo designed an implantable pacemaker in 1958. I have chosen to delete the edit on the grounds: 1. The ref 9 is only a Template Title. 2. A Google indicates that Dr Pombo has an extensive history in surgery, but no substantiation found for the claim. It is possible that Dr Pombo designed an implantable pacemaker in 1958, about the same time as Senning in Sweden, but in the absence of a reliable source which verifies the claim, and which in particular gives details of the design & where and when implanted, the inclusion of the claim In History is not appropriate. All published histories of the subject as known to me make no reference to Dr Pombo; however if in fact Dr Pombo did design and implant a pacemaker in 1958 it is an important contribution which deserves recognition in Wikipedia.Geoffrey Wickham (talk) 03:59, 7 December 2008 (UTC)