Pacemaker Power Sources

The first successful clinical pacemaker1 Tused a zinc-mercury primary battery. This same battery (the Rubin-Mallory cell) was to power most implantable pacemakers for the next 15 years, even though it restricted their service life to an average of only two years.2 Since the average patient in complete heart block with Stokes-Adams syndrome survives about six years, this meant that the average patient would have three pacemakers in his lifetime. The objective thus came to be a ten-year power source, which would then provide some 80 percent of all patients with a life-Fl time pacemaker, barring complications gure 1 Zinc-mercury cell layout in Medtronic 5850 pacemaker. Ten cells gave an unfrom other causes. This objective led to the loaded output voltage of 13.5 V. (1961 examination of every conceivable power source. Each one considered fell by the pair. An external stimulator generated an his heart would stop. Also, the device was wayside for one reason or another, until the audio pulse and applied it to a primary coil electrically inefficient because of the airadvent of the lithium anode battery with taped to the skin over the implanted receivcore transformer and thus battery drain any one of a number of cathode systems. er module, which then delivered a biphasic was rather high. Batteries had to be In one stroke, the battery was eliminated impulse to epicardial electrodes on the changed often, adeptly and quickly so as as the predominant limiting factor in paceheart. For some years, Abrams was able to not to lose stimulation for too long. One of maker longevity. Today, the lithium battery, report reliability figures that considerably Abrams' designs had two batteries so that in a number of forms, powers probably 98 surpassed those of our early total implants. one at a time could be changed, and power percent of all implantable pacemakers This device was manufactured for some was never lost. Another design had a very made. It is instructive to trace this develyears by the Lucas Company, automotive large electrolytic storage capacitor across opment by a detailed examination of each suppliers, in Birmingham, England. the battery, which could operate the pacebattery system. Then, some of the newer liGlenn, et al.4 reported a considerably maker for several seconds while changing thium oxyhalide, silver vanadium pentoxmore sophisticated system that included the battery. ide, and carboflouride systems that will berectification means in the implanted modThese were the first systems. They gencome commonly available as this decade ule and used an RF carrier wave with a erally predated total implants, and repprogresses will be examined. more efficient coupling than Abram's airresented courageous and commendable incore transformer. This device was mannovations on the part of their developers. Transcutaneous power systems ufactured for a time by Airborne InstruHowever, they never achieved extended The simplest system, with the most poments Laboratories of Mineola, New York, popularity because the rehabilitation they tential device longevity, would be an imin a group led by Walter Tolles, one of the offered was far from complete. The patient planted system with no battery at all! Sevefounding members of our Society. A third was always acutely aware of the device, ral groups have actually made such device by Camilli, et al.5 in Italy avoided and to accommodate it had to modify daily pacemakers. Abrams et al.3 in England, relead problems by miniaturizing the receiver activities. ported a system whose implanted portion module and mounting it directly on the epiconsisted only of a coil and an electrode cardium. Biological batteries All three of these systems saw some The human body contains many of the clinical use, but all three suffered from one chemicals necessary for electrochemical Mr. Greatbatch Is President of Greatbatch common disadvantage. The external device production of electricity in a battery-like Enterprises, Inc., Clarence, New York. He used a primary transmitting coil that had to fashion. Racine and Massie,6 Roy, et al.,7 is Adjunct Full Professor of Electrical Engibe taped to the skin over the implanted reSchaldach,8 and others have considered bineering at the State University of New York ceiver. Should the coil fall away, cardiac ogalvanic cells. Cywinski9 has carried such at Buffalo and Adjunct Professor of Physistimulation stopped. The patient's pattern a cell to three years of successful animal cal Sciences at Houghton College, Houghof living thus was severely affected. Neiuse. Others have considered fuel cell reacton, New York. He received the B.E.E. in ther a tub bath nor a shower was allowed (a tions utilizing oxygen from arterial blood 1950 from Cornell University, Ithaca, New sponge bath was permitted). The patient and hydrogen from body proteins. No biYork, and the M.S.E.E. in 1957 from the Uniperiodically had to carefully retape the priological battery has yet seen any clinical versity of Buffalo, Buffalo, New York. He is mary coil in a new position, with the tape use to date, and this system is considered an IEEE Fellow, a member since 1946, and on fresh skin to avoid irritation; all this a dead issue as far as any practical pacea charter member of EMBS. without dropping the coil, in which case makers are concerned.