The History of the Modern Pacemaker and Symptomatic Bradycardia
The year was 1952 and Paul Zoll introduced the first transcutaneous cardiac pacemaker to treat symptomatic bradycardia. Six years later, the first successful implantation of a pacemaker was performed in Sweden on Arne Larsson by performing a thoracotomy and suturing 2 epicardial electrodes to the heart. Now the first pacemaker only fired for three hours but we all know that sometimes it takes quite a few revisions and updates to improve upon an initial design and make it more reliable. Mr. Larsson received an additional 23 pacemaker replacements until he died in 2001. History is somewhat blurry as to when and who actually successfully implanted successive artificial pacemakers after this initial implantation. One thing we do know, however, is that today’s artificial pacemaker has come a long way since the initial successful implantation in 1958.
Today’s pacemakers have a much better track record for reliability and longevity with the average life expectancy of an implanted artificial pacemaker right around 15 years. The longest surviving patient with the same implanted pacemaker for over 30 years. They are much smaller and much more efficient than their earlier counterparts. The first pacemaker control unit was the size of a portable television unit while today’s units are no larger than a couple of stacked silver dollars in size. Early artificial pacemakers had a very short battery life and often failed unexpectedly while current devices are very consistent and reliable and have a battery life between 6-10 years. Today’s pacemakers also can be “interrogated” to glean information about not only the device’s activity but the patient’s rhythm history.
Many famous persons have had artificial cardiac pacemakers. In the entertainment field, performers like Elton John, Sal Hudson (Slash from Guns and Roses), Ric Flair, David Hasselhoff, and even Krusty (the character from the Simpsons cartoon. Leaders like Bob Dole, Dianne Feinstein, Pope Benedict XVI and Dick Cheney. Regardless of fame, fortune or life status, artificial pacemakers have been shown to prolong life span and improve overall quality of life. Syncopal episodes due to low heart rate are no longer an issue and the patient will often be able to return to an almost normal level of activity after the artificial pacemaker is implanted and will require little follow-up with their providers in regards to symptomatic bradycardia.
One relatively rare complication of having a pacemaker is Twiddler’s Pacemaker Syndrome. It is an uncommon cause of pacemaker malfunction and it is caused by accidental or deliberate movement of the implanted pacemaker generator by the patient. This manipulation can cause the leads to coil and become dislodged resulting in failure or dysfunction of the pacemaker’s pacing abilities. Other more common malfunctions are caused by lead failure, battery failure, pulse generator malfunction, electrolyte imbalances, inflammation, cardiac hypoxia and cardiomyopathies.
Improvements in artificial cardiac pacing are visible on the horizon. Artificial Intelligence (AI) using adaptive learning algorithms based on analyzed data, creating biologic pacemakers from stem cells or gene therapy and harnessing energy from the patient’s body, While the future is unclear, one thing is obvious. Artificial pacemakers have not only come a long way due to technological advances, quality of life and expected life expectancy have improved also over the past 60 years since the invention of this life saving and life altering device.
