Eugene Braunwald 1 has compared the intense activity in cardiology between 1950 and 1990 to the systolic phase of the heartbeat. In the present paper, we discuss one important aspect of the broader transformation of cardiovascular medicine: the development of pacemaker technology to treat bradyarrhythmias. (Tachypacing and the implantable cardioverter-defibrillator, innovations of the 1980s, ar...

Since 1958, totally implantable pacemakers have been used to stimulate the hearts of patients suffering from chronic heart block. The evidence that such patients have a reduced mortality rate in comparison with unpaced patients (Sowton, 1967) and the ability to return to a normal life have meant that pacemaker implantation for heart block is now accepted practice. There have been increasing num...

Right ventricular perforation is a rare but serious complication of permanent pacemaker and implantable cardioverter-defibrillator implantation, with a reported prevalence rate of 0.1-6%. Generally, there is a high incidence of asymptomatic lead perforation with otherwise normal function. Some patients present with a stabbing chest pain and shortness of breath or pacemaker malfunction. However,...

Spinal cord stimulators (SCS) are a well-recognised treatment modality in the management of a number of chronic neuropathic pain conditions, particularly failed back syndrome and radiculopathies. The implantable pulse generator (IPG) component of the SCS is designed and operates in a similar fashion to that of a cardiac pacemaker. The IPG consists of an electrical generator, lithium battery, tr...

Having a pacemaker has been seen an absolute contraindication to having an MRI scan. This has become increasingly difficult in clinical practice as insertion of pacemakers and implantable cardiac defibrillators is at an all time high. Here we outline a case where a 71-year-old male patient with a permanent pacemaker needed to have an MRI scan to ascertain the aetiology of his condition and help...

In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in ...

Introduction One of the most feared complications of a traditional pacemaker system is cardiac implantable electronic device infection. In such cases, a complete removal of the entire system is recommended. With the advent of the leadless transcatheter pacemaker system (TPS), the weak link— namely, the pacing leads that contribute to this problem— can be ultimately eliminated. At least 2 major ...

Surgical lead placement is generally considered as a last resort for patients who require permanent pacing and who are unable to accommodate transvenous leads. The technique is limited by the need for direct epicardial access and reduced reliability of epicardial leads (compared with modern transvenous leads) [Belott and Reynolds. Permanent pacemaker and implantable cardioverter defibrillator i...

The US Food and Drug Administration (FDA) has defined a medical device as a health care product that does not achieve it's purpose by chemical action or by being metabolized. This means that a vast number of products are considered medical devices. Such devices play an essential role in the practice of medicine. The FDA classifies medical devices in three classes, depending on the risk of the d...

Advances in implantable device technology over the past few years can be seen in these illustrations. The photograph on the left shows a 1997-model implantable cardioverter-defibrillator (ICD) in front of an older version. Beside it is a modern single-chamber pacemaker in front of an older mercury-zinc–cell model. The Table shows their relative weights. These devices are now small enough to per...