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Encyclopedia > Artificial pacemaker
A pacemaker, scale in centimeters
A pacemaker, scale in centimeters

A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker) is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's native pacemaker is not fast enough, or there is a block in the heart's electrical conduction system. Modern pacemakers are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Some combine a pacemaker and implantable defibrillator in a single implantable device. Others have multiple electrodes stimulating differing positions within the heart to improve synchronisation of the lower chambers of the heart. Image File history File links Download high-resolution version (723x790, 167 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Artificial pacemaker ... Image File history File links Download high-resolution version (723x790, 167 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Artificial pacemaker ... The contractions of the heart are controlled by electrical impulses, these fire at a rate which controls the beat of the heart. ... An electrode is an electrical conductor used to make contact with a metallic part of a circuit (e. ... The heart and lungs, from an older edition of Grays Anatomy. ... Heart rate is a term used to describe the frequency of the cardiac cycle. ... The sinoatrial node (abbreviated SA node, also called the sinus node) is the impulse generating (pacemaker) tissue located in the right atrium of the heart. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... ... ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ... In the heart, a ventricle is a heart chamber which collects blood from an atrium (another heart chamber that is smaller than a ventricle) and pumps it out of the heart. ...

Contents

History of the artificial pacemaker

In 1889 J A McWilliam reported in the British Medical Journal of his experiments in which application of an electrical impulse to the human heart in asystole caused a ventricular contraction and that a heart rhythm of 60-70 beats per minute could be evoked by impulses applied at spacings equal to 60-70/minute.[1] In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. ... In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ...


In 1928 Dr Mark C Lidwell of the Royal Prince Alfred Hospital of Sydney, supported by physicist Edgar H Booth of the University of Sydney, devised a portable apparatus which "plugged into a lighting point" and in which "One pole was applied to a skin pad soaked in strong salt solution" while the other pole "consisted of a needle insulated except at its point, and was plunged into the appropriate cardiac chamber". "The pacemaker rate was variable from about 80 to 120 pulses per minute, and likewise the voltage variable from 1.5 to 120 volts" The apparatus was used to revive a stillborn infant at Crown Street Women's Hospital, Sydney whose heart continued "to beat on its own accord", "at the end of 10 minutes" of stimulation.[2][3] Royal Prince Alfred Hospital The Royal Prince Alfred Hospital, commonly RPA, is a major hospital in Sydney, Australia, located on Missenden Road in Camperdown. ... The University of Sydney, established in Sydney in 1850, is the oldest university in Australia. ... Crown Street Womens Hospital (now-closed) was once the largest maternity hospital in Sydney, New South Wales, Australia. ...


In 1932 American physiologist Albert Hyman, working independently, described an electro-mechanical instrument of his own, powered by a spring-wound hand-cranked motor. Hyman himself referred to his invention as an "artificial pacemaker", the term continuing in use to this day.[4][5] Albert S. Hyman, (1893 - 1972), a New York cardiologist, together with his brother Charles, constructed in 1930-1932 an electro-mechanical device which was one of the earliest artificial pacemakers. ...


An apparent hiatus in publication of research conducted between the early 1930s and World War II may be attributed to the public perception of interfering with nature by 'reviving the dead'. For example, "Hyman did not publish data on the use of his pacemaker in humans because of adverse publicity, both among his fellow physicians, and due to newspaper reporting at the time. Lidwell may have been aware of this and did not proceed with his experiments in humans".[3] Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000...


An external pacemaker was designed and built by the Canadian electrical engineer John Hopps in 1950 based upon observations by cardio-thoracic surgeon Wilfred Gordon Bigelow at Toronto General Hospital . A substantial external device using vacuum tube technology to provide transcutaneous pacing, it was somewhat crude and painful to the patient in use and, being powered from an AC wall socket, carried a potential hazard of electrocution of the patient by inducing ventricular fibrillation. John Alexander Jack Hopps (1919 – November 24, 1998) is the Canadian inventor of the worlds first artificial pacemaker and is known as the father of biomedical engineering in Canada. Born in Winnipeg, Manitoba, he received a B.Sc. ... Dr. Wilfred Gordon Bill Bigelow, OC , MD , LL.D , FRSC (June 18, 1913 – March 27, 2005) was a Canadian heart surgeon known for his role in developing the artificial pacemaker and the use of hypothermia in open heart surgery. ... The R.R. McEwen atrium of the Toronto General Hospital, southwest corner of the site, view from University Avenue. ... Structure of a vacuum tube diode Structure of a vacuum tube triode In electronics, a vacuum tube, electron tube, or (outside North America) thermionic valve or just valve, is a device used to amplify, switch or modify a signal by controlling the movement of electrons in an evacuated space. ... Transcutaneous pacing (also called external pacing) is a temporary means of pacing a patients heart during a medical emergency. ... The term electrocution can mean either: accidental death or suicide by electric shock deliberate execution by electric shock, usually involving an electric chair The term is often used incorrectly to refer to a non-fatal event of electric shock. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ...


A number of innovators, including Paul Zoll, made smaller but still bulky transcutaneous pacing devices in the following years using a large rechargeable battery as the power supply. One of the pioneers of the cardiac pacemaker and cardiac defibrillator. ... Transcutaneous pacing (also called external pacing) is a temporary means of pacing a patients heart during a medical emergency. ...


In 1957 Dr. William L. Weirich published the results of research performed at the University of Minnesota. These studies demonstrated the restoration of heart rate, cardiac output and mean aortic pressures in animal subjects with complete heart block through the use of a myocardial electrode. This effective control of postsurgical heart block proved to be a significant contribution to decreasing mortality of open heart surgery in this time period. "Weirich W, Gott V, Lillehei C: The treatment of complete heart block by the combined use of a myocardial electrode and an artificial pacemaker. Surg. Forum 1957;8;360-363" This article is about the oldest and largest campus of the University of Minnesota. ... A heart block is a disease in the electrical system of the heart. ... Myocardium is the muscular tissue of the heart. ... Cardiac surgery is surgery on the heart, typically to treat complications of ischemic heart disease (e. ...


The development of the transistor and its first commercial availability in 1956 was the pivotal event which led to rapid development of practical cardiac pacemaking. For other uses, see Transistor (disambiguation). ...


In 1957 engineer Earl Bakken of Minneapolis, Minnesota, produced the first wearable external pacemaker for a patient of Dr. C. Walton Lillehei. This transistorised pacemaker, housed in a small plastic box, had controls to permit adjustment of pacing heart rate and output voltage and was connected to electrode leads which passed through the skin of the patient to terminate in electrodes attached to the surface of the myocardium of the heart. Earl Bakken and Palmer Hermundslie founded Medtronic in 1949 in Minneapolis, Minnesota. ... Dr. C. Walton Lillehei (October 23, 1918–July 5, 1999) is known as the Father of Open-Heart Surgery. ... Myocardium is the muscular tissue of the heart. ...


The first clinical implantation into a human of a fully implantable pacemaker was in 1958 at the Karolinska University Hospital in Solna, Sweden, using a pacemaker designed by Rune Elmqvist and surgeon Åke Senning, connected to electrodes attached to the myocardium of the heart by thoracotomy . The device failed after three hours. A second device was then implanted which lasted for two days. The world's first implantable pacemaker patient, Arne Larsson, survived the first tests and died in 2001 after having received 22 different pacemakers during his lifetime. Rune Elmqvist (1906-1996), a Swedish inventor, developed the first implantable pacemaker in 1958, working under the direction of Ã…ke Senning, senior physician and cardiac surgeon at the Karolinska University Hospital in Solna, Sweden. ... Myocardium is the muscular tissue of the heart. ... Thoracotomy is a surgical incision into the chest. ...


In 1959 temporary transvenous pacing was first demonstrated by Furman et al in which the catheter electrode was inserted via the patient's basilic vein. "Furman S, Schwedel JB : An intracardiac pacemaker for Stokes-Adams Seizures.(see Stokes-Adams attack). N Eng J Med 1959; 261:943-948" Temporary transvenous cardiac pacing, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ...


In February,1960, an improved version of the Swedish Elmqvist design was implanted in Montevideo, Uruguay in the Casmu Hospital by Doctors Fiandra and Rubio. That device lasted until the patient died of other ailments, 9 months later. The early Swedish-designed devices used rechargeable batteries, which were charged by an induction coil from the outside. Department Montevideo Department Altitude 43 m Coordinates 34º 53S 56º 10W Founded 1726 Founder Bruno Mauricio de Zabala Population 1,325,968 (2004) (1st) Demonym Montevideano Phone Code +02 Postal Code 10000 Montevideo (IPA: ) is the capital, largest city, and chief port of Uruguay. ...


Implantable pacemakers constructed by the American Wilson Greatbatch entered use in humans from April 1960 following extensive animal testing. The Greatbatch innovation varied from the earlier Swedish devices in using primary cells (mercury battery) as the energy source. The first patient lived for a further 18 months. Wilson Greatbatch is an inventor who advanced the development of early implantable cardiac pacemakers. ... For other uses, see Animal testing (disambiguation). ... A mercury battery (also called mercuric oxide battery, or mercury cell) is a non-rechargeable electrochemical battery, a primary cell. ...


The first use of transvenous pacing in conjunction with an implanted pacemaker was performed at the Hopital Tenon of Paris, France, in 1963 by Dr Jean-Jacques Welti. The transvenous, or pervenous, procedure involved incision of a vein into which was inserted the catheter electrode lead under fluoroscopic guidance, until it was lodged within the trabeculae of the right ventricle. This method was to become the method of choice by the mid-1960s.[6] Temporary transvenous cardiac pacing, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... A modern fluoroscope. ... A trabecula (plural trabeculae) is a small, often microscopic, tissue element in the form of a small beam, strut or rod, generally having a mechanical function, and usually but not necessarily composed of dense collagenous tissue. ...


The preceding implantable devices all suffered from the unreliability and short lifetime of the available primary cell technology which was mainly that of the mercury battery. In the late 1960s several companies, including ARCO in the USA, developed isotope powered pacemakers, but this development was overtaken by the development in 1970 of the lithium-iodide cell by Wilson Greatbatch. Lithium-iodide or lithium anode cells became the standard for future pacemaker designs. A mercury battery (also called mercuric oxide battery, or mercury cell) is a non-rechargeable electrochemical battery, a primary cell. ... Wilson Greatbatch is an inventor who advanced the development of early implantable cardiac pacemakers. ...


A further impediment to reliability of the early devices was the diffusion of water vapour from the body fluids through the epoxy resin encapsulation affecting the electronic circuitry. This phenomenon was overcome by encasing the pacemaker generator in an hermetically sealed metal case, initially by Telectronics of Australia in 1969 followed by Cardiac Pacemakers Inc of Minneapolis in 1972. This technology, using titanium as the encasing metal, became the standard by the mid-1970s. In chemistry, epoxy or polyepoxide is a thermosetting epoxide polymer that cures (polymerizes and crosslinks) when mixed with a catalyzing agent or hardener. Most common epoxy resins are produced from a reaction between epichlorohydrin and bisphenol-A. The first commercial attempts to prepare resins from epichlorohydrin occurred in 1927 in... Telectronics was an Australian company best known for its role in developing the pacemaker. ...

  • Acknowledgements:

Others who contributed significantly to the technological development of the pacemaker in the pioneering years were Bob Anderson of Medtronic Minneapolis, J.G (Geoffrey) Davies of St George's Hospital London, Barouh Berkovits and Sheldon Thaler of American Optical, Geoffrey Wickham of Telectronics Australia, Walter Keller of Cordis Corp. of Miami, Hans Thornander who joined previously mentioned Rune Elmquist of Elema-Schonander in Sweden, Janwillem van den Berg of Holland and Anthony Adducci of Cardiac Pacemakers Inc.(Guidant) There have been several people named Bob Anderson: Bob Anderson, deceased former Formula One driver. ... Medtronic, Inc. ... St Georges Hospital, founded in 1733, is a teaching hospital in London. ... Barouh Berkovits is one of the pioneers of Bio-engineering; particularly the cardiac defibrillator and artificial cardiac pacemaker. ... Geoffrey G. Wickham was one of the pioneers of cardiac pacemaking and co-founder of Telectronics. ... Telectronics was an Australian company best known for its role in developing the pacemaker. ... Walter Keller cardiac pacemaker history. ... Cordis is: A medical device company owned by Johnson & Johnson. ... Hans Thornander cardiac pacemaker history. ... Rune Elmquist cardiac pacemaker history. ... 20 november 1920 - 18 oktober 1985 Janwillem van den Berg was a Dutch speech scientist who did much to prove the myoelastic-aerodynamic theory of voice production. ... Anthony J. Adducci ( August 14, 1937 – September 19, 2006) was a pioneer of the medical device industry in Minnesota. ... Wikinews has news related to this article: Guidant announces more defibrillator problems Guidant Corporation NYSE: GDT designs and manufactures artificial pacemakers, implantable defibrillators, stents, and other cardiovascular medical products. ...


Applications

Artificial pacemakers can be used in order to help with and/or treat these conditions:

Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... The sinoatrial node (abbreviated SA node, also called the sinus node) is the impulse generating (pacemaker) tissue located in the right atrium of the heart. ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ... The sinoatrial node (abbreviated SA node, also called the sinus node) is the impulse generating (pacemaker) tissue located in the right atrium of the heart. ... The atrioventricular node (abbreviated AV node) is an area of specialized tissue between the atria and the ventricles of the heart, which conducts the normal electrical impulse from the atria to the ventricles. ...

Methods of pacing

Transcutaneous pacing

Main article: Transcutaneous pacing

Transcutaneous pacing (TCP), also called external pacing, is recommended for the initial stabilization of hemodynamically significant bradycardias of all types. The procedure is performed by placing two pacing pads on the patient's chest, either in the anterior/lateral position or the anterior/posterior position. The rescuer selects the pacing rate, and gradually increases the pacing current (measured in mA) until electrical capture (characterized by a wide QRS complex with a tall, broad T wave on the ECG) is achieved, with a corresponding pulse. Pacing artifact on the ECG and severe muscle twitching may make this determination difficult. External pacing should not be relied upon for an extended period of time. It is an emergency procedure that acts as a bridge until transvenous pacing or other therapies can be applied. Transcutaneous pacing (also called external pacing) is a temporary means of pacing a patients heart during a medical emergency. ... Bradycardia, as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. ... “QRS” redirects here. ... “QRS” redirects here. ...


Transvenous pacing

Main article: Transvenous pacing

Transvenous pacing, or temporary internal pacing, is an alternative to transcutaneous pacing. A wire is placed under sterile conditions via a central venous catheter. The proximal tip of the wire is placed into either the right atrium or right ventricle. The distal tip of the wire is attached to the pacemaker generator, outside of the body. Transvenous pacing is often used as a bridge to permanent pacemaker placement. Under certain conditions, a person may require temporary pacing but would not require permanent pacing. In this case, a temporary pacing wire may be the optimal treatment option. Temporary transvenous cardiac pacing, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. ... In medicine, a central venous catheter (CVC or central venous line) is a catheter placed into a large vein in the neck, chest or groin, this is inserted by a physician when the patient needs more intensive cardiovascular monitoring, for assessment of fluid status, and for increased viability of intravenous...


Permanent pacing

Permanent pacing with an implantable pacemaker involves placement of one or more pacing wires within the chambers of the heart. One end of each wire is attached to the muscle of the heart. The other end is screwed into the pacemaker generator. The pacemaker generator is a hermetically sealed device containing a power source and the computer logic for the pacemaker. This article is about the machine. ...


Most commonly, the generator is placed below the subcutaneous fat of the chest wall, above the muscles and bones of the chest. However, the placement may vary on a case by case basis.


The outer casing of pacemakers is so designed that it will rarely be rejected by the body's immune system. It is usually made of titanium, which is very inert in the body. A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... General Name, symbol, number titanium, Ti, 22 Chemical series transition metals Group, period, block 4, 4, d Appearance silvery metallic Image:Ti, 22. ...


Basic pacemaker function

Modern pacemakers usually have multiple functions. The most basic form listens to the heart's native electrical rhythm, and if the device doesn't sense any electrical activity within a certain time period, the device will stimulate the ventricles of heart with a set amount of energy, measured in volts. The more complex forms include the ability to sense and/or stimulate both the atrial and ventricular chambers.

The revised NASPE/BPEG generic code for antibradycardia pacing[7]
I II III IV V
Chamber(s) paced Chamber(s) sensed Response to sensing Rate modulation Multisite pacing
O = None O = None O = None O = None O = None
A = Atrium A = Atrium T = Triggered R = Rate modulation A = Atrium
V = Ventricle V = Ventricle I = Inhibited V = Ventricle
D = Dual (A+V) D = Dual (A+V) D = Dual (T+I) D = Dual (A+V)

Biventricular Pacing (BVP)

A biventricular pacemaker, also known as CRT (cardiac resynchronization therapy) is a type of pacemaker that can pace both ventricles (right and left) of the heart. By pacing both sides of the heart, the pacemaker can resynchronize a heart that does not beat in synchrony, which is common in heart failure patients. CRT devices have three leads, one in the atrium, one in the right ventricle, and a final one is inserted through the coronary sinus to pace the left ventricle. CRT devices are shown to reduce mortality and improve quality of life in groups of heart failure patients.[8][9] The coronary sinus is a collection of veins joined together to form a large vessel that collects blood from the myocardium of the heart. ...


CRT has been shown to improve health of patients with certain types of heart failure [10]. CRT can be combined with an implantable cardioverter-defibrillator (ICD) [11]. ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ...


Advancements in pacemaker function

When first invented, pacemakers controlled only the rate at which the heart's two largest chambers, the ventricles, beat. In the heart, a ventricle is a heart chamber which collects blood from an atrium (another heart chamber that is smaller than a ventricle) and pumps it out of the heart. ...


Many advancements have been made to enhance the control of the pacemaker once implanted. Many of these enhancements have been made possible by the transition to microprocessor controlled pacemakers. Pacemakers that control not only the ventricles but the atria as well have become common. Pacemakers that control both the atria and ventricles are called dual-chamber pacemakers. Although these dual-chamber models are usually more expensive, timing the contractions of the atria to precede that of the ventricles improves the pumping efficiency of the heart and can be useful in congestive heart failure. In anatomy, the atrium (plural: atria) refers to a chamber or space. ...


Rate responsive pacing allows the device to sense the physical activity of the patient and respond appropriately by increasing or decreasing the base pacing rate via rate response algorithms.


The DAVID trials[12] have shown that unnecessary pacing of the right ventricle can lead to heart failure. New devices can keep the amount of right ventricle pacing to a minimum and thus prevent worsening of the heart disease.


Another advancement in pacemaker technology is left ventricular pacing. A pacemaker wire is placed on the outer surface of the left ventricle, with the goal of more physiological pacing than available in standard pacemakers. The extra wire is implanted to improve symptoms in patients with severe heart failure.[citation needed]


Other devices with pacemaker function

Main article: Implantable cardioverter-defibrillator

Sometimes devices resembling pacemakers, called ICDs (implantable cardioverter-defibrillators) are implanted. These devices are often used in the treatment of patients at risk from sudden cardiac death. An ICD has the ability to treat many types of heart rhythm disturbances by means of pacing, cardioversion, or defibrillation. ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ... ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ... Through electricity or drug therapy, cardioversion converts heart arrhythmias to normal rhythms. ... Typical view of the defibrillator operator. ...

NASPE / BPEG Defibrillator (NBD) code - 1993[13]
I II III IV
Shock chamber Antitachycardia pacing chamber Tachycardia detection Antibradycardia pacing chamber
O = None O = None E = Electrogram O = None
A = Atrium A = Atrium H = Hemodynamic A = Atrium
V = Ventricle V = Ventricle V = Ventricle
D = Dual (A+V) D = Dual (A+V) D = Dual (A+V)
Short form of the NASPE/BPEG Defibrillator (NBD) code[13]
ICD-S ICD with shock capability only
ICD-B ICD with bradycardia pacing as well as shock
ICD-T ICD with tachycardia (and bradycardia) pacing as well as shock

See also

Cardiology is the branch of medicine pertaining to the heart. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... The terms atomic battery, nuclear battery and radioisotope battery are used to describe a device which uses the charged particle emissions from a radioactive isotope to directly generate electricity. ... Transcutaneous pacing (also called external pacing) is a temporary means of pacing a patients heart during a medical emergency. ...

References

  1. ^ "Electrical Stimulation of the Heart in Man - 1889", Heart Rhythm Society, Accessed May 11, 2007
  2. ^ Lidwell M C, "Cardiac Disease in Relation to Anaesthesia" in Transactions of the Third Session, Australasian Medical Congress, Sydney, Australia, Sept. 2-7 1929, p 160.
  3. ^ a b Mond H, Sloman J, Edwards R (1982). "The first pacemaker". Pacing and clinical electrophysiology : PACE 5 (2): 278-82. PMID 6176970. 
  4. ^ Aquilina O, "A brief history of cardiac pacing", Images Paediatr Cardiol 27 (2006), pp.17-81.
  5. ^ Furman S, Szarka G, Layvand D, "Reconstruction of Hyman's second pacemaker", Pacing Clin Electrophysiol.2005 May;28(5):446-453
  6. ^ Jean-Jacques Welti:biography.Heart Rhythm Foundation.[1]
  7. ^ Bernstein A, Daubert J, Fletcher R, Hayes D, Lüderitz B, Reynolds D, Schoenfeld M, Sutton R (2002). "The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group". Pacing Clin Electrophysiol 25 (2): 260-4. PMID 11916002. 
  8. ^ Cleland JGF, Daubert J-C, Erdmann E, et al; the Cardiac Resynchronization — Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005 March 7 Fulltext. PMID 15753115.
  9. ^ Bardy GH, Lee KL, Mark DB, et al for the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352:225–237
  10. ^ Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L (2005). "The effect of cardiac resynchronization on morbidity and mortality in heart failure". N Engl J Med 352 (15): 1539-49. PMID 15753115. 
  11. ^ Bristow M, Saxon L, Boehmer J, Krueger S, Kass D, De Marco T, Carson P, DiCarlo L, DeMets D, White B, DeVries D, Feldman A (2004). "Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure". N Engl J Med 350 (21): 2140-50. PMID 15152059. 
  12. ^ Wilkoff BL, Cook JR, Epstein AE, et al.: Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual-chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002, 288: 3115–3123. [2]
  13. ^ a b Bernstein A, Camm A, Fisher J, Fletcher R, Mead R, Nathan A, Parsonnet V, Rickards A, Smyth N, Sutton R (1993). "North American Society of Pacing and Electrophysiology policy statement. The NASPE/BPEG defibrillator code". Pacing Clin Electrophysiol 16 (9): 1776-80. PMID 7692407. 

  Results from FactBites:
 
Artificial pacemaker - Wikipedia, the free encyclopedia (1692 words)
A pacemaker (or "artificial pacemaker", so as not to be confused with the heart's natural pacemaker) is a medical device designed to regulate the beating of the heart.
The purpose of an artificial pacemaker is to stimulate the heart when either the heart's native pacemaker is not fast enough or if there are blocks in the heart's electrical conduction system preventing the propagation of electrical impulses from the native pacemaker to the lower chambers of the heart, known as the ventricles.
The pacemaker generator is a hermetically sealed device containing a power source and the computer logic for the pacemaker.
  More results at FactBites »

 
 

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