cardiovascular
The leadless pacemaker : A new era in cardiac pacing
From the breakthroughs of early pioneers to the present day , the quest to improve outcomes and reduce complications goes on
Seth Dockrill MBBS MRCP Patrick Heck MD DM FRCP Papworth Hospital NHS Foundation Trust , Cambridge , UK
Figure 1 Micra™ Transcatheter Pacing System
On 8 October 1958 in Stockholm , Sweden , a 43-year-old man , Arne Larsson , became the first patient to undergo implantation of a permanent pacemaker . Physician turned engineer , Rune Elmqvist , and cardiac surgeon , Åke Senning , had been developing a battery powered implantable system for electrical cardiac stimulation , when Larsson ’ s wife appealed to Senning , asking him to help her husband who had been hospitalised with increasingly frequent Stokes Adams attacks . Forty-three years after that first pacemaker implantation , Arne Larsson died at the age of 86 years from melanoma , having outlived both Elmqvist and Senning . Over the course of his lifetime , Larsson received a total of 22 pacemaker generators and five lead systems . 1
In the years since Elmqvist and Senning began their pioneering work , implant techniques have evolved . That first implantation involved a left sided thoracotomy , and the placement of epicardial leads which were tunnelled to the pacemaker pulse generator , situated in the abdominal wall . 1 Today the leads are almost always placed endocardially via the venous system of the upper limb – cephalic , axillary or subclavian – and the pulse generator sits in a subcutaneous pocket in the infra-clavicular region , on top of , or occasionally beneath , the pectoral muscle .
Pacemaker technology has also developed significantly over the years . Early batteries used nickel cadmium or zinc mercury , and had limited durability . Today ’ s lithium-iodinepolyvinylpyridine batteries allow for smaller devices with much greater longevity . Lead
11 HHE 2018 | hospitalhealthcare . com