ASAIO GOLD

The 25 Landmark ‘Milestone’ Papers Published by ASAIO

1955-2003

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Pacemakers and Defibrillators

1. Chardack WM, Gage AA, Greatbatch W, "Experimental Observations and Clinical Experiences with the Correction of Complete Heart Block by an Implantable Self-Contained Pacemaker," TASAIO 1961, p.286 Chardack WM, Gage AA, Greatbatch W, "Experimental Observations and Clinical Experiences with the Correction of Complete Heart Block by an Implantable Self-Contained Pacemaker," TASAIO 7: 286-295, 1968.

Commentary: This is a wonderful article classically describing early experience with an implantable pacemaker. With the state of the art in electrophysiology as it is today, it is difficult to conceive of the structure and function of the first pacemakers--huge in size because of the large mercury batteries; heavy (one-half pound); fixed rate (some rate and amplitude adjustability could be applied via a transcutaneous Keith, 3-sided needle); implanted via thoracotomy (induction of anesthesia not infrequently accompanied by cardiac arrest). Nonetheless, these same scientists went on to develop more efficient sources of energy, such as lithium in various combinations. Much credit goes to the space programs for the miniaturization of electronic components which have been of value to the medical device industry. The accompanying illustrations with this article are magnificent in the portrayal of the early attempts at technology of this sort. – W. Gerald Rainer, M.D.

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2. Schuder JC, Stoeckle H, Gold JH, West JA, Keskar PY, "Experimental Ventricular Defibrillation with an Automatic and Completely Implanted System," TASAIO 16:207-212, 1970.

Commentary: A result of studies from the University of Missouri, this paper deals with the development of an implantable ventricular defibrillator, just as crude when compared with the transvenous systems of today as were the early pacemakers. The application of inefficient sensing and countershock delivery resulted in multiple instances of inadvertent and alarming shocks to the patients. Implantation was a major surgical adventure with abdominal wall placement of the power unit being required to accommodate the weight and bulk of the unit. Fortunately, technology has advanced rapidly in this field and many of the problems associated with earlier units have been overcome. – W. Gerald Rainer, M.D.

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