Implantable Pacemakers A Twenty Five Year Journey

Wilson Greatbatch, F.I.E.E.E., P.E. Senning in Stockholm attempted the first human implant. Dr. Greatbatch Enterprises, Inc. Senning's device was not clinically successful. It worked only three hours and then failed. A replacement worked eight FOREWORD days, after which the patient went unstimulated for some ARLIER this year the National Society of Professional three years (6). Later, Senning recommended abandonment EEngineers, as part of their 50th Anniversary Celebration, of the procedure (7). In 1960, our group accomplished the selected the pacemaker as one of the ten outstanding first clinically successful implant (8). engineering developments of the last fifty years. Similarly, In 1958, we foresaw an optimistic annual usage of perhaps our EMB Society awarded one of its Centennial Medals, and 10,000 pacemakers. In a remarkably short time, the implantthe North American Society for Pacing and Electrostimulation able pacemaker became the treatment of choice for complete conferred its "Scientist of the Year Award" for the same heart block with Stokes-Adams syndrome. Today, pacecontribution. makers have assumed forms and functions that we never Actually, the pacemaker represents a prime example of an dreamed of and the world pacemaker market is now well over interdisciplinary development deriving from the work of 300,000 units per year. literally hundreds of engineers, physicians, electrochemists, In 19481 was a "G.l. Bill" student at Cornell University. To nuclear physicists and a host of other professionals from feed my family of five, I worked part-time at many jobs on every conceivable calling. The awards we received were campus. One was running the University radio station really awards to all of them. (WHCU, 1 kw AM; 100 kw FM). Another was instrumenting The first implantable cardiac pacemaker in an experimental eggs for impedance measurements in the Poultry Departanimal was implanted by our group on May 7, 1958 (1). ment. Still another was instrumenting 100 sheep and goats Within five years, the implantable pacemaker had come to be for physiological measurements relating to Pavlovian psythe treatment of choice for complete heart block with Stokeschology and conditioned reflex. All this was most useful Adams syndrome, and now for a growing number of less experience in preparation for a decade later, when we built ominous indications. In 1960 our group implanted clinical the astronaut instrumentation for the first space monkeys. devices of our design in 10 patients. By 1983, some 300,000 One summer, two New England neurosurgeons came on new pacemakers per year were being implanted throughout sabbatical to do experimental surgery on the hypothalmus of the world and usage in the USA approached one per thousand goats. They carried their lunches in brown paper bags, as I of population (2). did, and we spent many noon-hours sitting in the Ithaca sun, talking shop. learned much practical physiology from them. INTRODUCTION They told me about complete heart block. knew I could fix it, Some of the elements of pacing can be traced back to the but not with the vacuum tubes and storage batteries we had work of Callaghan and Bigelow (3) in 1951 in Toronto. They at the time. demonstrated stimulation of the heart, both with epicardial I carried this problem in my mind through two years and transvenous electrodes in connection with animal experibuilding airborne computers at Cornell Aeronautical Laboraments on hypothermia, but they did not carry their work tory in Buffalo, and then into teaching electrical engineering further. at the University of Buffalo, not knowing that Paul Zoll was The first practical external pacemaker was built by Zoll (4). building his historic pacemakers in Boston at the time. This device was line operated delivering high-voltage pulses In 1956, the first good silicon transistors became available to skin electrodes. This treatment was painful and burned the (at $90 each). Then I knew I could build an implantable skin, but many lives were saved. Lillehei, et al. (5) used pacemaker. By 1958, 1 had a functioning breadboard using a Bakken's hand-held, battery operated stimulator on myocarUTC DOT-1 transformer in a two-transistor blocking oscilladial wires, operating at a power level two orders of magnitude tor. lower than Zoll's device. This technique eliminated the pain I found little enthusiasm locally for an implantable paceand burning. With the addition of a transvenous catheter, maker. Each medical group I approached said, "Fine idea, but Bakken's stimulator became the standard method of tempomost of these patients die in a year or so. Why don't you work rary pacing, which is still used today. on my project?" Then one day in the Spring of 1958, 1 visited May 7, 1983 marked the twenty-fifth anniversary of the Dr. William Chardack, Chief of Surgery at the Veteran's first implanted cardiac pacemaker. On that day, our group Administration Hospital in Buffalo. implanted a self-powered cardiac pacemaker in an experimenIn Buffalo we had the world's first local chapter of the tal animal (1). Later the same year, in October, Dr. Ake Institute of Radio Engineers, Professional Group in Medical Electronics, (the predecessor of our present Society). Every month 25 to 75 doctors and engineers met for a technical l~ l~ i l ___program. We strove to attract equal numbers of doctors and I I I I I 11I engineers. We had a standing offer to send an engineering team to assist any doctor who had an instrumentation l problem. I went with one team to visit Dr. Chardack on a problem dealing with a blood oximeter. Imagine my surprise ~,to find that his assistant was my old high-school classmate, fndy Gage! We couldn't help Dr. Chardack much with his oximeter problem, but when I broached my pacemaker idea to him, he walked up and down the lab a couple of times, looked