Cardiac Pacemakers Biological Aspects

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- Clinical usage of artificial pacing dates back to 1958, when the battery powered cardiac pacemakers became available. Modern implantable pacemakers are the complicated electronic devices operating 10 years continuously without battery exchange. Though the development of devices is not a primary topic of the book, certain efforts towards developing of biologic pacemakers through tissue engineering and studying of cell synchronization are discussed. The main attention is paid to implementations of pacemakers in different medical situations oriented towards widening the clinical indications for implanting the cardiac pacemakers. New methods and devices in cardiac resynchronization therapy (CRT) have received particular attention. Placing of pacing electrodes has been treated soundly. Furthermore, emerging of complexities and complications in new clinical situations and other safety problems have been discussed thoroughly. The authors have derived the used information from their own clinical practice and experiences of their medical colleagues. These and other pragmatic features can be acknowledged as the most valuable asset of the book.
- The use of artificial pacing has a marvellous history – clinical applications of cardiac pacing are known since 1958, when Earl Bakken, a co-founder of the company Medtronic in Minneapolis, USA, designed and produced a wearable electronic pacemaker for a patient of Dr. C. Walton Lillehei, a pioneer in open heart surgery. In October 1958, the first cardiac pacemaker was implanted at the Karolinska Institute in Solna near Stockholm, Sweden, by surgeon Dr. Åke Senning. This transistorized and battery powered pacemaker was designed by Rune Elmqvist and manufactured in Siemens-Elema, a predecessor of today's St. Jude Medical Sweden AB. Availability of miniaturized cardiac pacemakers was connected with emerging of the era of silicon based electronics – first transistors, then integrated circuits. Nowadays pacemakers are complicated electronic devices, containing, besides a multiple-output generator of electrical pulses, sensing and computing units together with control and communication components for achieving the well-functioning demand-responsive pacing. Installed batteries can ensure about 10-years power supply. Dual-chamber synchronized pacing of both, right atrium and right ventricle, is already in common clinical use. Moreover, left ventricle pacing in cardiac synchronization therapy (CRT) is also introduced and used clinically in different ways and modes. Further development of pacemakers as electronic devices will not stop in the near future, but this is not a straightforward subject of this book.

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Cardiac Pacemakers Biological Aspects

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