Implantable Cardiac Electrostimulation Devices

  • Rick McVenesEmail author
  • Ken Stokes
Part of the Biological and Medical Physics, Biomedical Engineering book series (BIOMEDICAL)


The history of bradycardia (too slow heart beat) goes back 300 years, but implantable pacemakers made their appearance in 1959. Since then, as pacemakers became more sophisticated, the indications for their use have expanded greatly. Today they are used to treat numerous rhythm disturbances including some forms of tachycardia (too fast a heart beat), heart failure, and even stroke (thromboembolism due to atrial fibrillation). Implantable cardioverter defibrillators (ICD) made their appearance in 1980. Today they are used to correct tachycardia, ventricular fibrillation, and even asystole (no heart beat) as well as heart failure patients. These are highly sophisticated devices made from very high reliability components.


Cardiac Resynchronization Therapy Implantable Cardioverter Defibrillator Stimulation Threshold Cardiac Vein Sense Amplifier 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Furman S (2000) Introduction: History of cardiac pacing. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 1–13Google Scholar
  2. 2.
    Adams R (1827) Cases of diseases of the heart accompanied with pathological observations. Dublin Hosp Rep. 4: 396Google Scholar
  3. 3.
    Stokes R (1846) Observations on some cases of permanently low pulse. Dublin Q J Med Sci 2: 73Google Scholar
  4. 4.
    Bernstein AD and Parsonnet V (2000) Pacemaker, defibrillator, and lead codes. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 327–332Google Scholar
  5. 5.
    Hoorweg JL (1892) Condensatorentladung und auseinandersetzung mit du Bois-Reymond. Pflugers Arch 52: 87–108CrossRefGoogle Scholar
  6. 6.
    Weiss G (1902) Sur la possibilite’ de render comparable entrre les appareils cervant a’ l’excitation electrique. Arch Ital Biol 35: 413Google Scholar
  7. 7.
    Lapique L (1909) Definition experimentale de l’excitabilite. C R Soc Biol 67: 280Google Scholar
  8. 8.
    Nernst W (1908) Zur theorie des electrischen reizes. Pflugers Arch 122: 275–314CrossRefGoogle Scholar
  9. 9.
    Schecter DC, Lillehei CW and Soffer A (1972) Background of clinical cardiac electrostimulation. NY St J Med 72: 605–609Google Scholar
  10. 10.
    Mond H, Sloman G and Edwards R (1981) The first artificial pacemaker. PACE 4: 60Google Scholar
  11. 11.
    Zoll P, et al. (1961) Long term electrical stimulation of the heart for Stokes-Adams disease. Ann Surg 154: 330CrossRefGoogle Scholar
  12. 12.
    Lillehei CW, Gott VL, Hodges PC, et al. (1960) Transistor pacemaker for treatment of complete atrioventricular dissociation. JAMA 172: 2006–2010CrossRefGoogle Scholar
  13. 13.
    Elmvquist R and Senning A (1959 and 1960) Implantable pacemaker for the heart. In: Smyth CN (ed.) Medical electronics, Iliffe & Sons Ltd, Paris and LondonGoogle Scholar
  14. 14.
    Greatbatch W and Chardack WM (1959) A transistorized implantable pacemaker for the long term correction of complete atrioventricular block. M Electron NEREM 48: 643Google Scholar
  15. 15.
    Cammilli L, Ricci D, Risani R, et al. (1979) PH triggered pacemaker and clinical results. In: Meere CD (ed.) Proceedings of the VIth world symposium on cardiac pacing. PACESYMP, Montreal, Chapter 19–8Google Scholar
  16. 16.
    Rickards AF and Norman J (1981) Relation between Q-T interval and heart rate: New design of physiologically adaptive cardiac pacer. Br Heart J 45: 56–61CrossRefGoogle Scholar
  17. 17.
    Leung S-K, Lau C-P and Camm JA (2000) An overview of sensors: Ideal characteristics. Sensor combinations and automaticity. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 219–248Google Scholar
  18. 18.
    Hunter S, Boldiuc L, Long V, et al. (1973) A new myocardial pacemaker lead (sutureless). Chest 63: 430CrossRefGoogle Scholar
  19. 19.
    Furman S and Robinson G (1958) The use of an intracardiac pacemaker in the correction of total heart block. Surg Forum 9: 245Google Scholar
  20. 20.
    Siddons H and Davies J (1968) A new technique for internal cardiac pacing. Lancet 2: 1204Google Scholar
  21. 21.
    Hori M (1977) Round table world survey. In: Watanabe Y (ed) Cardiac pacing. Excerpta Medica, Amsterdam p. 556Google Scholar
  22. 22.
    Painter MW, Harrington OB, Crosby VG, et al. (1979) Implantation of an endocardial tined lead to prevent early dislodgment. J Thorasc Cardiovas Surg 77: 249Google Scholar
  23. 23.
    Bisping HJ and Rupp H (1977) A new permanent transvenous electrode for fixation in the atrium. In: Watanabe Y (ed.) Proceedings of the Vth International symposium on cardiac pacing. Excerpta Medica, Amsterdam pp. 543–547Google Scholar
  24. 24.
    Littleford PO, Parsonnet V and Spector SD (1979) Method for rapid and atraumatic insertion of permanent endocardial electrodes through the subclavian vein. Am J Cardiol 43: 980CrossRefGoogle Scholar
  25. 25.
    Belott PH and Reynolds DW (2000) Permanent pacemaker and implantable cardioverter-defibrillator implantation. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 573–644Google Scholar
  26. 26.
    Nissen RG, Holmes DR, Maloney JD, et al. (1979) Experience with permanent cardiac pacemakers in congenital heart disease. In: Meere C (ed.) PACESYMP, Montreal, Proceedings of the VIth world symposium on cardiac pacing, Chapter 23–2Google Scholar
  27. 27.
    Tabrisky J, Jobe WE, Newman MB, et al. (1967) Internal cardiac pacemakers. Amer J Roentgenology 100: 446–456Google Scholar
  28. 28.
    Benchimol A and Liggett MS (1966) Cardiac hemodynamics during stimulation of the right atrium, right ventricle, and left ventricle in normal and abnormal hearts. Circulation, XXXIII: 933–944Google Scholar
  29. 29.
    Smyth NPD, Vasarhely L, McNamara W, et al. (1969) A permanent transvenous atrial electrode catheter. J Thorac Cardiovasc Surg 58: 773Google Scholar
  30. 30.
    DeFrancis NA and Giordano RP (1968) Permanent epicardial atrial pacing in the treatment of refractory ventricular tachycardia. Am J Cardiol 22: 742–745CrossRefGoogle Scholar
  31. 31.
    Padeletti L, Porciani MC, Michelucci A, et al. (1998) Interatrial septum pacing: A new approach to prevent paroxysmal atrial fibrillation. PACE 21(Pt. II): 797Google Scholar
  32. 32.
    Daubert C, Gras D, Leclercq C, et al. (1995) Biatrial synchronous pacing: A new therapeutic approach to prevent refractory atrial tachyarrhythmias. PACE 18(Pt. II): 1781Google Scholar
  33. 33.
    Nathan DA, Center S, Wu C-Y, et al. (1963) An implantable synchronous pacemaker for the long term correction of complete heart block. Circulation 27: 682–685Google Scholar
  34. 34.
    Funke HD (1979) Eighteen (18) months of clinical experience with the implantable optimized sequential stimulator. PACE 2: A-44 (251)Google Scholar
  35. 35.
    Faerestrand S and Ohm O-J (1985) A time-related study of the hemodynamic benefit of atrioventricular synchronous pacing Evaluated by Doppler echocardiography. PACE 8: 838–848CrossRefGoogle Scholar
  36. 36.
    Santini M, MacCarter D, Knudson M, et al. (1981) Automatic atrial rate responsive VVI pacing: A simple physiological approach. PACE 4: A–72Google Scholar
  37. 37.
    Tse H-F, Lau C-P, Leung S-K, et al. (1996) Single lead DDD system; Comparative evaluation of unipolar, bipolar and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing. PACE 19(11 part II): 1758–1763CrossRefGoogle Scholar
  38. 38.
    Bakker P, Sen KCA, de Jonge N, et al. (1995) Biventricular pacing improves functional capacity in patients with end-stage congestive heart failure. PACE 18(4 Pt. II): 825Google Scholar
  39. 39.
    Cazeau S, Ritter P, Lazarus A, et al. (1996) Multisite pacing for end-stage heart failure: Early experience PACE 19(Pt II): 1748–1757CrossRefGoogle Scholar
  40. 40.
    Cazeau S, Leclercq C, Lavergne T, et al. (2001) Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344: 873–80CrossRefGoogle Scholar
  41. 41.
    Abraham WT, Fisher WG, Smith AL, et al. (2002) Cardiac resynchronization in chronic heart failure, N Engl J Med 346:1845–1853CrossRefGoogle Scholar
  42. 42.
    Bristow MR, Feldman AM, Saxon LA (2000) Heart failure management using implantable devices for ventricular resynchronization: Comparison of medial therapy, pacing, and defibrillation in chronic heart failure (COMPANION) trial. J Card Fail 6: 276–285CrossRefGoogle Scholar
  43. 43.
    Ritter P, Gras D, Bakdach H, et al. (1998) Material-related complications of multisite pacing in end-stage heart failure. Archives Des Maladies Du Coeur Et Des Vaisseauz 91: 143Google Scholar
  44. 44.
    McVenes R, Stokes K, Christie M, et al. (1998) Technical aspects of simultaneous biventricular stimulation thresholds. Archives des Maladies du Coeur et des Vaisseauz 91(3): 152Google Scholar
  45. 45.
    VonLudinghausen M (1987) Clinical anatomy of cardiac veins, Vv. Cardiacae Surg Radiol Anat 9: 159–168CrossRefGoogle Scholar
  46. 46.
    Hill MRS, Connors SP and Hassan A (2000) Coronary venous vasculature in congestive heart failure patients: Opportunities for left ventricular pacing. Europace. I: D238Google Scholar
  47. 47.
    Asirvatham SJ, Talreja DR, Gami AS, et al. (2001) Coronary venous drainage of the lateral left ventricle: Implications for biventricular pacing. Circulation 104(17): II–619Google Scholar
  48. 48.
    October 18, (2000) Medtronic AttainTM side-wire lead model 4191 study closure report 1.1Google Scholar
  49. 49.
    Garrigue S, Jaïs P, Espil G, et al. (2001) Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using Doppler tissue imaging in patients with heart failure. Am J Cardi 88: 858–862CrossRefGoogle Scholar
  50. 50.
    Leclercq F, Hager FX, Marcia JC, et al. (1999) Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure. PACE 22: 1570–1575CrossRefGoogle Scholar
  51. 51.
    Gold MR and Rashba EJ (1999) Left ventricular endocardial pacing: Don’t try this at home. PACE 22: 1567–1569CrossRefGoogle Scholar
  52. 52.
    Leclercq F, Kassnasrallah S, Macia JC et al. (2000) Transcranial doppler detection of microemboli during endocardial biventricular pacing in end-stage heart failure. J Am Coll Cardiol 35(Suppl A): 141–A34Google Scholar
  53. 53.
    Jais P, Takahashi A, Garrigue S, et al. (2000) Mid-term follow-up of endocardial biventricular pacing. PACE 23:1744–1747Google Scholar
  54. 54.
    McVenes R and Christie M (2002) LV endocardial and triple site stimulation–Insights to the mechanism of cardiac resynchronization. Europace 3(Suppl A): 176Google Scholar
  55. 55.
    Warren JA and Nelson JP (2000) Pacemaker and ICD pulse generator circuitry. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 194–216Google Scholar
  56. 56.
    Miroski M (1970) Standby automatic defibrillator. Arch Intern Med 126: 158CrossRefGoogle Scholar
  57. 57.
    Thomas AC, Moser SA, Smutka ML, et al. (1988) Implantable defibrillation: Eight years of clinical experience. PACE11: 2053–2056CrossRefGoogle Scholar
  58. 58.
    Winkle RA, Mead H, Ruder MA, et al. (1989) Long-term outcome with the automatic implantable cardioverted-defibrillator. J Am Coll Cardiol 13: 1353CrossRefGoogle Scholar
  59. 59.
    Untereker DF, Shepard RB, Schmidt CL, et al. (2000) Power systems for implantable pacemakers, cardioverters and defibrillators. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 167–193Google Scholar
  60. 60.
    Owens BB (ed) (1986) Batteries for implantable biomedical devices. Plenum, New YorkGoogle Scholar
  61. 61.
    Bornzin GA, Stokes KB and Wiebusch WA (1983) A low-threshold, low-polarization platinized endocardial electrode. PACE 6: A–70Google Scholar
  62. 62.
    DelBuffalo AGA, Schlaepfer J, Fromer M, et al. (1993) Acute and long-term ventricular stimulation thresholds with a new, iridium oxide-coated electrode. PACE 16: 1240CrossRefGoogle Scholar
  63. 63.
    Schaldach M, Hubman M, Weikl A, et al. (1990) Sputter-deposited TiN electrode coatings for superior sensing and pacing performance. PACE 13: 1891CrossRefGoogle Scholar
  64. 64.
    Elmqvist H, Schuller H and Richter G (1983) The carbon tip electrode. PACE 6: 436CrossRefGoogle Scholar
  65. 65.
    Stokes KB, Taepke R and Gates J (August 1994) All impedances are not created equal: Expediency vs efficiency. Medtronic Sci Technol 3(1): 2–12Google Scholar
  66. 66.
    Stokes K (March 1995) Estimating pulse generator longevity. Medtronic Sci Technol J 3(2): 26–28Google Scholar
  67. 67.
    Stokes KB, Bornzin GA and Wiebusch WA (1983) A steroid-eluting, low-threshold, low-polarizing electrode. In: Steinbach K (ed.) Cardiac Pacing, Steinkopff verlag, Darmstadt, pp. 369–376CrossRefGoogle Scholar
  68. 68.
    Stokes K and Cobian K (1982) Polyether polyurethanes for implantable pacemaker leads. Biomaterials 3: 225–231CrossRefGoogle Scholar
  69. 69.
    Stokes KB, Frazer WA and Christopherson RA (1984) Environmental stress cracking in implanted polyurethanes. Second world congress on biomaterials, 10th Annual Meeting of the Society for Biomaterials p. 254Google Scholar
  70. 70.
    Stokes KB, Urbanski P and Upton J (1990) The in vivo autooxidation of polyether polyurethane by metal ions. J Biomater Sci, Poly Ed 1(3): 207–230CrossRefGoogle Scholar
  71. 71.
    Medtronic Inc (2007) Cardiac rhythm disease management, Product Performance report, 2nd edn., Issue no 57.
  72. 72.
    Tyers F, Yeung J, Mills P, et al. (May 1997) 3 Year experience: New atrial and ventricular coradial bipolar leads. PACE 20(Pt II): 1475Google Scholar
  73. 73.
    Schüller H, Fahraeus T, Thuesen L, et al. (1995) First clinical experience with an automatic output adaption pacemaker based on evoked response. PACE 18(4, Pt II): 824CrossRefGoogle Scholar
  74. 74.
    Livingston AR, Callaghan FJ, Byrd CL, et al. (1988) Atrial capture detection with endocardial electrodes. PACE 11(11 Pt2): 1770–1776CrossRefGoogle Scholar
  75. 75.
    ACC/AHA/NASPE Guidelines: Indications for pacing and ICD therapy. http://www.patientcareonline
  76. 76.
    Gillis AM (2000) Sinus node disease. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 405–425Google Scholar
  77. 77.
    Saksena S, Mehra R and Ellenbogen KA (2000) Pacing for prevention of tachyarrhythmias. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 479–496Google Scholar
  78. 78.
    Sheldon RS and Jaeger FJ (2000) Carotid sinus hypersensitivity and neurally mediated syncope. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 455–478Google Scholar
  79. 79.
    Wilkoff BL and Firstenberg MS (2000) Cardiac chronotropic responsiveness. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 508–532Google Scholar
  80. 80.
    Gold MR and Peters RW (2000) Pacing in patients with heart failure. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 497–507Google Scholar
  81. 81.
    Janosik DL and Ellenbogen KA (2000) Basic physiology of cardiac pacing and pacemaker syndrome. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 333–382Google Scholar
  82. 82.
    Morgan DE, Norman R, West RO, et al. (1986) Echocardiographic assessment of tricuspid regurgitation during ventricular demand pacing. Am J Cardiol 58(10): 1025–1029CrossRefGoogle Scholar
  83. 83.
    King DH, Gillette PC, Shannon C, et al. (1983) A steroid eluting endocardial pacing for treatment of exit block. Am Heart 106: 1438CrossRefGoogle Scholar
  84. 84.
    Byrd CL and Wilkoff BL (2000) Techniques and devices for extraction of pacemaker and implantable cardioverter-defibrillator leads. In: Ellenbogen KA, Kay GN and Wilkoff BL (eds.) Clinical cardiac pacing and defibrillation, 2nd edn. WB Saunders, Philadelphia, pp. 695–709Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Leads Research, Cardiac Rhythm Disease Management Division, Medtronic, Inc.Mounds ViewUSA
  2. 2.Brady Leads Research, Cardiac Rhythm Disease Management Division, Medtronic, Inc.BrainerdUSA

Personalised recommendations