October 9, 2013 • 33 mins
What is a pacemaker? How do pacemakers control the rate of heartbeats? What was the first pacemaker?
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Episode Transcript
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Speaker 1 (00:04):
Get in tests with technology with text stuff from half
stuff works dot com. Hey there, and welcome to textuff
on Jonathan Stricklin. Today we're going to talk about pacemakers.
So these little medical devices that are incredible. I mean,
these are life saving devices that have made countless people's
(00:28):
lives better. It's impossible. It's it's when when the electrical
impulses of your heart are less good than they should be. Wait, whoa,
whoa electrical impulses, Lauren, Now you're talking crazy talk. What
do you mean electrical impulses. That's that's how the heart works.
There's crazy there. We we we have natural pacemakers, and
(00:48):
sometimes they work less well than others. But so yeah,
so so. Pacemakers are are small devices that are implanted
nearish the heart, in the general chest, airs, cavity, shoulder,
abdomen's where on there. They use low energy electrical impulses
to help control any abnormal heart rhythms um sometimes called
arrhythmias rhythmia. Thank you, I had an arrhythmia as a child,
(01:11):
did you. Yep? I had an arrhythmia and a heart murmur.
Wow that's exciting in the bad way. So anyway, so
those can be that your heart is beating either too fast,
too slow, or irregularly. And um, there are more long
words for all of those things, which right now there's
there's a tachycardia there you go, yeah, and breda cardia. Yes,
so those are the too so breda cardias if it's
(01:34):
beating too slowly, and tachycardia is when it's too quickly. Sure,
there's also other conditions that can that can wrap up
into needing a pacemaker a k A. M. Atrial fibrilation
in which the upper chambers of the heart kind of
quiver instead of really contracting. Yeah. So, in order for
you to really understand what we're talking about here, the
(01:56):
heart is divided up into four chambers right right, the
left and right atria, which are the upper chambers, and
the left and right ventricles, which are the lower chambers. Right,
So the upper chamber chambers, the atria, when they when
they contract, they force blood down into the ventricles, which
then when they can try to force it throughout the
rest of the body. And so the combination of these
(02:16):
two contractions are what we think of the heartbeat. The
whole love dub dub is that. Yeah, So that's you know,
the love the atria and the dub the ventricles, so
you know that there's just plenty of room for romance.
But so if if one of these is not working
out correctly, then it's it's a huge problem. Right. So,
(02:36):
if the atria are doing this fibrillation where they are
quivering instead of beating, then it's not providing the right
amount of blood to the ventricles to pump it through
the rest of the body. That's all obviously an issue,
but there's another one too. Write there's also heart block,
in which the electrical signal is slowed or disrupted as
it moves through the heart. So again the problem with
actually the signal reaching the place where it needs to
(02:58):
go so that you have a healthy heartbeat. Right. It's
it's like if the cover on your wire is a
little bit screwy something something to that extent, except the
wires your heart and you need that wire pretty badly. Yeah,
it's it's um. Unless you're the tin man, you pretty
much need one. And these conditions can be caused by
all kinds of disease and other wackiness that could be.
(03:22):
It could be an inherited condition, it can be after
a heart attack, if if a heart attack damages the muscle, right, yeah,
there are injuries that can end up injuring the heart
as a as a result. Yeah. So there's lots of
different ways that this could happen, including things like just
coming out of a surgery that's unrelated to your heart. Sure, absolutely, Okay,
So so what happens when your heart lacks rhythm? You
(03:44):
can no longer do really crazy dances like the electric slide. Okay,
true enough. However, it mostly means that your body might
not be getting enough blood, which would cause a tiredness, lightheadedness,
breathlessness even like fainting, organ damage, and and can potentially
even lead to death if it goes unchecked. Yeah. Yeah,
so we're talking about very serious stuff. Now. A healthy
(04:08):
adult has a heart rate at rest. That's what between
sixty beats permant something like that. Ye ye, so um,
mind's on the high end, which is actually not great.
It means that, honestly, that Jonathan needs to exercise more
so that I have a healthier cardio life. And that's
something that I am working on because it's a concern, right,
I'm getting I'm getting to a certain age um physically
(04:31):
if not mentally or emotionally, so I need to prepare
for that. Generally, slower heartbeat within that range is is ideal.
Um and healthy heartbeats are regular because we have, like
I said earlier, those built in pacemakers. Those are the
sino ar trial I said that right, Yes, which at
the at the at the upper right. Okay, gotcha. So yeah,
(04:53):
so it's this is kind of the signal that lets
the atria no to to contract. So once that signal
goes through to contract the atria, what happens then, Like,
how is it then move onto the ventricle um, it
passes through another node, the atrio ventricular nod. Well, yeah, okay, cool.
(05:13):
So you've got two nodes that are doing this and
they're doing it in a very precise rhythm so that
it creates this contraction that that then pumps the blood
through the rest of the body. All right, And if
that's atrial node isn't working properly, the atrio ventricular node
can take over for it. But it's a it's it's
a weaker force, so it's not as efficient, it's not
(05:34):
as efficient. It's only going to get you up to
about forty beats per minute. Which, um, is why you're
going to encounter that fatigue and breathlessness and stuff like that. Right,
So you'll you'll you'll live, but you'll be getting an
increasingly poor condition. Um. So what do pacemakers do. Pacemakers
can can regulate that they can help slow the rhythm
(05:56):
of a too fast heartbeat or help control and a
regular or too fast form or too slow them. So
they can they can monitor the impulses and override it
or pulses, I guess I should say, and override it
so that it has a more regular heartbeat and keep
someone at an optimal heartbeat range. Right. Sure, And and
(06:16):
if those if those two nodes are not communicating properly,
a pacemaker can help coordinate the electrical signals between them.
I see. So if maybe the cino ore atrial nodes
working just fine, but perhaps the ventricular ones not, then
this could help balance that balance that out right? Sure?
And it does this because okay, So, so a pacemaker
(06:37):
is essentially a very small generator hooked up to a
battery and a computer. Again, very small battery and very
small computer. You have to be implant the sure um
and wires are threaded from the pacemaker through a vein
to the heart. Um. Those wires being tipped with electrodes,
and the electrodes detect your heart's electrical activity and rhythm
(06:59):
and then send that information to the computer which will
monitor them. Um and then uh, it will direct the
generator to fire whenever the signals go go wnkey all right.
So what the computer is doing is looking for any irregularities,
share addresses that right. Um. It can also record these
signals for your doctor to upload and used to adjust
your pacemaker. Um using a wireless device. They don't have
(07:21):
to do surgery on you and check it because they
want to check it about quarterly, so that would be messy.
So this is kind of like a very important version
of a physical activity tracker. It's keeping data on the
activity of your heart and let your doctor know exactly
what's going on right right um. In some cases, that
onboard computer can even be accessed remotely via the interwebs.
(07:41):
So for those of you who are privacy worried about
that kind of thing, the idea that your heart rate
is being monitored remotely maybe not for you. I actually
think I actually think it's super awesome, Like the idea
that that a doctor would have that level of granular
information about a pay stients health and and even be
(08:02):
able to preemptively tell the patient, hey, I'm detecting some
unusual readings here. Could you come in so that we
can make sure that you are in good shape, that
you're in good shape, and that it's not an equipment malfunction.
And you know, obviously that would be incredibly important. And
if it were, you know, I mean there's some some
people have pacemakers who are who are basically doing okay,
(08:23):
it's more precautionary, and but there are other very life
threatening ventricular diseases. Sure, sure, yeah, some models, called great
responsive models will actually adjust to your heart rate to
your changes in activity. Gotcha is like, which again makes sense.
For example, like if you're exerting yourself, then you might
need a different heart rate than if you were at rest.
(08:45):
And uh that's why I remember older pacemakers that was
a real challenge because they would they would keep a
very steady heart rate, which was great, but if you
break into a brisk jug your heart wouldn't be able
to to keep up when the in the computer would
start misfire. Right, So that was a real issue. Sure sure, so, um,
So there are three basic types of pacemakers. You've got
(09:05):
single chamber which carry impulses from the generator to the
heart's right ventricle. Dual chamber which carry those impulses to
the right ventricle and the right atrium um and and
also helped coordinate the timing between the two. Then you've
got bi ventricular which which carry those impulses to the
right atrium and both ventricles helping coordinate all of the signals.
(09:26):
And uh, those are yeah for for as you can imagine,
those those are increasing in seriousness right right, obviously because
you're talking about having to take over more and more
of the hearts activity. There are all there are also
related UM implantable cardio verter cardioverter did I say that right? Yes,
implantable cardioverter defibrillators, which UM use not only those low
(09:47):
energy impulses that a regular pacemaker would use, but also
UM high high energy impulses when necessary to treat very
life threatening So like if you're for example, there I'll
t talk about some of the early ones of this,
but there are some devices that let's say the detects
at your heart that maybe you're going into cardiac arrest.
It can actually deliver a strong enough electrical impulse to possibly,
(10:11):
you know, kickstart your heart going again. So it ends
up being like you know, if you guys have ever
seen any medical procedural, you have obviously seen the person
with which they usually use incorrectly. Yeah, the clear part
is important, by the way, Yes, but now he's doing
poorly from too much electric Um. Yeah, that's ah. This
(10:33):
is something that's sort of an implantable device that does
a similar thing, although it does it in a very
precise way because it's delivering it directly to the heart
and um and and not every pacemaker does this. Um.
They can also, like Jonathan said earlier, be temporary if
you've just had if you've just had a heart attack
or surgery, or perhaps overdosed. While while the patient is
(10:55):
in the hospital with these kinds of issues, they might
have a temporary pacemaker. UM. And of course the permanent ones,
which is more what we've been talking about. I mean,
they wouldn't implant a temporary one, right, Yeah. In fact,
the earliest pacemakers are more like what you would see
with a temporary pacemaker, I mean, far the temporary ones
that we use now are far more sophisticated. Of course,
(11:15):
orders of magnitude more sophisticated. But the ideas that you
would have an external device that would be able, you know,
anyone could monitor and also be able to like a
medical professional would be able to disconnect it once that
was a viable option, and wires would go into you,
which is kind of, you know, depending upon your level
(11:36):
of comfort, a little squeaky, but I'm honestly pretty squeaked
out by the entire wire through a vein thing. Yeah. Well,
just wait until we talk about the history of pacemakers,
because it's going to get really interesting. I'm glad you
took that research. So, in the case of permanent pacemakers,
batteries and generators usually have to be replaced every five
to fifteen years, usually about six or seven. It's really
(11:59):
the battery start running down, and they figure, while we're
performing surgery on you, we might as well change out
the generator to make sure that it doesn't start running
down to right right, So that way, and it actually
decreases the number of surgeries you would need over the lifetime.
Over your lifetime, right sure, yeah, the lifetime of the product,
your lifetime, um and the wires may eventually need to
be replaced as well, but that's that's more case to
(12:22):
case basis. Right now, we talked about in our Electronics
and f A a episode about electromagnetic interference and even
discussed a little bit about how people with pacemakers need
to be careful around devices that emit E m I,
which is pretty much anything that's electrical, right right, And
that's because, like any electrical signal, the impulse is sent
(12:43):
by pacemaker can be disrupted by an electromagnetic field. Yeah. So, now, granted,
in most cases, the instructions you get are pretty pretty
common sense, and stuff like don't don't lay down and
put a laptop computer or a cell phone or for
your heart. Yeah you don't wanna, don't wanna have like
your cell phone in your shirt pocket for example, right right,
(13:05):
You know, avoid brushing up next to strong household appliances,
industrial welders. Don't lay directly against the microwave as you
wait for that sweet sweet popcorn to be delivered to
your hands. You know, keep keep it. Keep your generators.
You're you're larger than your heart generator generator at arms
length that don't use jackhammers kind of that kind of
(13:25):
I never do and everyone thanks me. Yeah, so's and
you know, I mean, things like metal detectors are are
fine if they're you know, I it's you're supposed to
tell security agents like, hey, I've got this pacemaker thing,
please kill me, and and they will know how to
deal with that. Yeah. So it's it's certainly one of
those things that does mean, you know, you have to
take that into account in your lifestyle. Sure, but it's
(13:48):
also development that has, like we said, given a huge
number of people a chance at a healthy life that
otherwise they would not have. So it's it's phenomenal technology.
We'll talk more about how we developed this technology over
years and years of experimentation, some of which enters into
(14:12):
the Frankenstein Mad Scientist realm. And I can't wait to
talk about it. But before we do, let's take a
quick break to thank our sponsor. Now let's get back
to talking about pacemakers. Now, in this particular episode, we
kind of divided up the research of it, so Lauren
ended up looking a lot at how the heart works
(14:34):
and how pacemakers tend to work. If you guys have
ever listened to for thinking, you know that I am
the medical correspondent. Yeah. Yeah, we we make her look
at all the squeaky stuff so we don't have to
because she likes squeaky stuff like um. Although slime, I
would slime is really great, guys. Although I would I
would argue glancing through your notes here for the history
(14:54):
that you actually got the short end of the squick stage.
You know what. This This is why never used the
phrase quick stick. This is a This is entering into
a realm that I actually relish, I because we're talking
about a realm of scientific exploration that definitely goes on
that mad scientist side of the scale. I mean, in
(15:15):
that really cool kind of Victorian era. And this this
is the same era where we saw things like Mary
Shelley's Frankenstein be published, and so that's you know, and
and some of the stuff that was being talked about
and discovered at this time plays into the narrative of
that story, although in a much more kind of literary
way and not a scientific way. But at any rate,
(15:36):
this is when we had people really thinking about electricity
and its effect on the human body, and not just
the human body as it turns out, So you really
need to talk about the history of the pacemaker have
to go all the way back to the mid seventeen hundreds.
That's when it's when people started to experiment with what
they called electro stimulation, using electricity to stimulate muscles. Uh.
(15:58):
And in fact, by this time they were looking at
cardiac electro stimulation, so again using electricity to stimulate the heart.
This was all in animals at the time. Yeah, So
they would find recently dead animals, or they would make
an animal recently dead, and then they would use some
form of electricity to use on electricity source to stimulate
(16:21):
the animal's heart. Electric sources. Yeah, at the time, they
had they had laden jars and voltaic piles peels Actually
you should say voltaic peels. It's it's actually named uh
it's yeah, so peel is French, but it's voltaic peels
or piles if you prefer both of which we were.
(16:41):
I mean our batteries. They are viable batteries, but very dangerous, yeah,
and not particularly strong unless you make huge stacks. Right.
So these are predecessors to what we consider the modern battery.
But that was when there was a lot of experimentation
going on. So they would use them to stimulate the
cardiac nerves and animals in an attempt to resuscitate intact
(17:03):
dead animals and thus, as my notes say, infect the
world with chipmunk zombies. Uh. So, there was a fellow
named Luigi Galvani who was credited with proposing electricity as
the mechanism that causes our muscles to operate. Now here's
the story. Uh, this is very possibly apocryphal, but the
(17:24):
the story the legend that Galvani was working on on
dissecting a little froggy and uh ended up building up
an electrostatic charge and picked up a scalpel and touched
the scalpel to the froggy and it discharged the electro
static charge, which created the spark and made the froggy's
(17:46):
leg twitch. Thus, Galvanni began to think of electricity as
being the means through which our muscles operate. He called
it animal electricity, as opposed to what was being called
heat electricity. So he's he thought that animal electricity was
some sort of electricity trical type of fluid that would
make muscles move. Before then, it was this idea of
(18:09):
laden jars were still based on the principle that electricity
was a fluid isn't that correct? Yeah, yeah, so we're
you know, this is obviously this is the early days
of learning about electricity. So uh. At any rate that
that research led other people to start to tinker around.
One of those was William Hawes h A W. E. S.
(18:30):
He established a society in London called the Humane Society.
But it's not the Humane Society the way we would
think of it in the United States. You hear the
Humane Society and you think, oh, that's an animal rescue.
It's not for adopting dogs and cats. Know, this was
a a group that was dedicated to um well, salvaging
people who appeared to be dead. This was a big
(18:50):
concern at the time a lot of people. You know,
we didn't really have the more precise scientific definitions and
even today's debatable of of what is alive and what
is dead, and we you know, we didn't have heart
rate monitors. It was a morbid time, really, it's what
it was. It was a lot harder to tell and
so there was a huge fear of getting buried alive. Yeah.
So there was also a similar society at the time
(19:13):
in Paris. Paris, Uh, I assume Paris friends and not Paris, Texas.
Eventually the organization would become the Royal Humane Society of London,
and very early on during this society's days, scientists began
to explore electro stimulation as a way of resuscitating people
who appear to have died and maybe who are not
(19:34):
actually dead but could be revived. So se A guy
named Charles Kite writes uh paper titled an Essay upon
the Recovery of the Apparently Dead, which is already my
favorite title of a of a paper since uh, since
more wrote Cramming more components on integrated circuits. Um, I love,
(19:55):
I love, I love these titles. They're better. That's the
best kind of research, really. So, according to the essay,
Ki used electro stimulation to treat a three year old child.
She had fallen out of a window and appeared to
be dead. They had called in an apothecary, who was
unable to do anything. Kite said that it was twenty
minutes before he could arrive to provide some sort of
(20:15):
electro stimulation to the child's heart. He used his He
used essentially electrodes to to deliver a gentle electrical shock
to various parts of the child's body eventually setting on
the thorax or chest really to uh and found that
he got a pulse when he did that, and claimed
that the child woke up was very groggy and uh
(20:37):
and and confused about her surroundings, but that she eventually
made a full recovery. What that tells me is that
this story is probably either exaggerated or there are some
big missing components, Because being dead for twenty minutes is
being dead is dead. You're not You're not You're not
bouncing back from that really, But any rate, it could
(20:59):
be that that no one at the house at the
time could find a heartbeat, right, could have been that
she had a very weak pulse interminute pulse. Even so,
at any rate, that's the story. From seventy six, a
couple of Danish scientists published a paper that was titled
Life Saving Measures for drowning persons and Information of the
best means by which they can be brought back to life,
(21:20):
and that also included electro stimulation of the heart as
a means of saving people. We're gonna jump ahead, so
a lot of people researching this. In eighteen twenty, Dr
de Sanctus in The Medical Guide described the reanimation chair.
I didn't show you a picture of this yet, have
I learned? You're gonna get a chance to see it
(21:42):
on social as well. The chair included bellows which were
meant to force air into the person's lungs, a metallic
tube inserted into the person's esophagus, and a voltaic peel
or pile, depending upon how you want to pronounce it,
attached at one end of the metal tube and the
other end was to an electrode. The electrode was then
to quote regions of the heart, the diaphragm, and the
(22:03):
stomach end quote to cause muscles to contract. If you
look at this thing, or illustrations of this thing, I
should say I haven't seen a picture of what I
don't know if one was ever actually built, but the
illustrations of what it was supposed to look like look
like it came from Hostile or Saw or one of
those movies. It is absolutely terrified to behold. It makes
a dentist chair look absolutely comforting by by comparison, I
(22:30):
look forward to it. Yeah, experiments with electro puncture, this
is where we're really getting into the fun stuff. So
that is that is combining electrical stimulation with acupuncture. So
you've got a needle that you insert into the body
of your your subject and then you shoot electricity through
it to stimulate. Yeah, well animal, it was most animals,
(22:53):
mostly dogs. Actually, uh yeah, I didn't want to dwell
on that too much because I love my doggies. So anyway,
it turned out the early experiments anyway, it turned out
to be i'll use the word failure, So no Frank
and doggies. From this particular early experimentation, however, other people
(23:14):
would start to experiment with using insulated needles that could
deliver an electrical shock to a specific point, the point
of the needle in fact, and that would in fact
be the basis for early pacemakers. Uh. They did discover
that by refining this process that they could stimulate activity
in a heart that was undergoing cardiac arrest. And again
(23:36):
they were using animals, and essentially, in order to experiment,
they would over a neesthetize animals in or to induce
cardiac arrest. So we would see more and more experiments
between eighteen twenty eight and nineteen thirty, which is the
next date I have on my my list, and I I
don't want to be too exhaustive with this, and also
and they get pretty weird. And uh yeah, when you
(23:57):
start talking about getting cadavers from recent executions, it starts
to get pretty grim. So I'm going to I'm gonna
skip over that. We skip over the entire Victorian era.
We skip over Jack the Ripper. Uh, listen to stuff
you missed in history class. They cover all that kind
of stuff. All right, it's n That's when a fellow
by name of Albert S. Hyman develops and patents the
(24:21):
artificial pacemaker. Yeah, so this thing did not look like
a pacemaker as you and I would would recognize if
we were to see one, which are which are large
coin sized. Yeah, they're they're in the Grand Scheme of
Medical Devices. They are tiny. Uh, this one was not tiny.
This was a hand crank. Okay, So you had a
(24:42):
hand crank and it had wires cables essentially that ended
in needles that could be inserted into a person and
by turning the hand crank. There was also a spring
motor inside of it that turned a magneto, which is
a d C current generator. So essentially what you're doing
is you're turning We've talked about inducing electricity to flow
by using moving a conductor through a fluctuating magnetic field.
(25:06):
This is a way of doing that by hand. You
turn the cranks. It's turning it through this magnetic field.
That's inducing electricity to throw to flow rather and that
ends up supplying the electricity needed for the pacemaker. The
insulation needle would deliver the electric charge to the right
atrium of the heart, and by March first, nineteen thirty two,
the pacemaker had been used forty three times with a
successful outcome in fourteen cases, which is about a thirty
(25:29):
three percent success rate, which sounds incredibly low, but then
keep in mind that the essentially this was an absolute
last Yeah, this was the last last ditch effort to
try and revive someone. So it wasn't like this what
These were not the type of pacemakers we've talked about
in our episode where we talked about the things that
you would have in your in your chest for a
(25:50):
prolonged period. This was really meant to revive someone. Yeah,
so this is this is a little different thing. Patient
saved is actually better and zero percent. So, uh, nineteen forties,
that's when they started to Engineers and doctors began to
work on designing defibrillators, which, as we said, can play
(26:10):
a part in some types of pacemakers that you can
find today that are it's kind of a combination device really.
Nine an elderly man who in the literature is called
h N. They don't obviously identify people because it's medical,
but h N suffered heart ailments for several years, had
had heart attacks and other irregularities, and became the recipient
(26:32):
of atronic products. Nine O two M battery operated pacemaker.
This was not an internal unit. It was not an
implant in that sense. They did implant the electrodes so
that they had contact with the heart, but the cables
to the actual device were external, and you would, you know,
have to carry the pacemaker around with you and it
(26:55):
was held outside the body. You know. It could also
detect spont aneas cardiac activity. It had essentially had the
ability to tell if something was going wrong. It wasn't
necessarily able to respond to that dynamically, but it could
at least warn a caregiver that something something was happening. Um,
everything was it was, It worked all right. The one
(27:19):
problem was that the area where the electrodes would go
in through the skin Essentially the needle would go in
through the skin um was prone to minor infections. There
was never like that you would expect from from I mean,
and that's part of the reason why the drive should
create implantable rightmakers exist. And we talked about, you know,
the fact that in our piercing episode or our body
(27:41):
modification episode, we talked about that there is a a
possibility of developing these kind of infections and they may
not be serious, it may not be life threatening, but
they can be problematic. And that was exactly what he
had experienced. It wasn't an infection that was developing into sepsis,
but it was like he would have to have the
area ened regularly so that he could clear out any infection. UH.
(28:03):
In late nineteen sixty two, he underwent surgery for a
pacemaker implant, but he never fully recovered. In fact, he
never recovered from the surgical procedure. He died twenty days
after the surgical procedure, So that was an unfortunate tragedy there,
but he did have lived for several years with this
external pacemaker. In nineteen sixty doctor Robert Rubio implant a
(28:26):
pacemaker into a female patient and that pacemaker was fifty
two point five millimeters in diameter, which is about two
inches uh seventeen point five millimeters thick, which is about
point seven inches, so just over half an inch, and
waged sixty four point three grams or two point three
ounces or less than a quarter of a pound. Now
that one got power from two rechargeable nickel cadmium batteries
(28:48):
which were charged through induction from an external flexible coil
placed on the skin over the pacemaker. So this is
the way some pacemakers are recharged today using a similar approach,
although it's usually radio frequencies. But what we're talking about
wireless power here right where you can induce this charging
through um again, your your cree. It's all about magnetic
(29:09):
fields and electricity is really what we get down to.
So you would have to place this flexible coil directly
over your heart in order to recharge the pacemaker, or
really directly over the pacemaker wherever the pacemaker was located,
wherever the you know, the battery was uh. The stimulated
electrode for this was a platinum disk, so it was
an expensive piece of medical technology. But sadly the patient
(29:32):
died nine and a half months after the surgery, because
she did develop an infection which turned into sepsis after
the surgery. So the pacemaker was working, but the it
was a side effect of the surgery. She unfortunately perished
from that. So early implannable pacemakers varied widely and how
long they could operate before requiring a recharge. So one
(29:53):
of them would only go like eight hours and then
you have to recharge it. That's pretty yeah, that's pretty yeah.
But there were others that could go weeks or even
months before a recharge, even in the early days in
the sixties. Uh this this also, I mean still today,
how much how much your your pacemaker is actually needing
(30:14):
to to create a charge will make your battery life
very right. So in other words, in other words, if
if it's only occasionally having to intervene, then you're recharging,
may you may not need to recharge it as frequently
as someone where it's more active more frequently. Um So,
in the nineteen sixties, that's when we started to see
the cardiac stimulator defibrillators, which we kind of talked about.
(30:37):
It's under called something else today, but same sort of
idea that the device that can uh detect when a
heart beat stops and then try to restart it with
a controlled electrical burst to the heart. Uh. The early
versions of that were also not implantable. They were external
as well. But now we've got implantable ones that are
(30:57):
incorporated with sort of pacemaker technology. UM. Now, as far
as the future goes, because from the nineteen sixties on
to the present, it was really refining that process. It's
just that miniaturization and in electrical stimulation yep, yep, making
sure that we were getting more precise and smaller. Those
are really the trends. So anything from nineteen sixties on
(31:19):
is more about refining that that design. Uh. Talking about
the future, miniaturization is going to continue to be a factor.
In fact, there are companies right now that are trying
to create pacemakers that are about the size of a pill.
So that tiny. So the reason why you want this
is not just because it it takes up less space
in the patient. Really, it's because the surgical procedures become
(31:40):
less invasive. It's less damaged to the body, less chance
for infection, UH, makes it less chance for something to
go wrong, because you're it's just it's just a smaller
surgical procedure. So that's really where we're seeing the future
come in as far as Pacemakers are concerned. And now
that kind of wraps up our our episode. We were
(32:01):
really interested in this topic. It was kind of it's
it's always fun for us to take a specific technology
and explain how it works and really where it came from.
We love doing that. I mean we obviously we love
doing things like covering various companies as well. Uh, not
to mention the fact that we have covered many, many,
many personalities in technology. But if you guys want to
hear us do more of this sort of thing, then
(32:24):
I recommend you right in and let us know. So
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we may take your your suggestion. This suggestion, by the way,
(32:47):
came to us from a listener right Facebook, from Peter. So, Peter,
I hope you enjoyed this episode about Pacemakers. I hope
you were not asking about Jerry and the Pacemakers, because
that's a band and they did very Across the Mercy,
which is a great song but not what we covered.
So hopefully we met your expectations. Let us know if
(33:07):
we didn't. And guys, that wraps this up. We will
talk to you again really soon for more on this
and thousands of other topics. Is it how stuff works
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Get in tests with technology with text stuff from half
stuff works dot com. Hey there, and welcome to textuff
on Jonathan Stricklin. Today we're going to talk about pacemakers.
So these little medical devices that are incredible. I mean,
these are life saving devices that have made countless people's
(00:28):
lives better. It's impossible. It's it's when when the electrical
impulses of your heart are less good than they should be. Wait, whoa,
whoa electrical impulses, Lauren, Now you're talking crazy talk. What
do you mean electrical impulses. That's that's how the heart works.
There's crazy there. We we we have natural pacemakers, and
(00:48):
sometimes they work less well than others. But so yeah,
so so. Pacemakers are are small devices that are implanted
nearish the heart, in the general chest, airs, cavity, shoulder,
abdomen's where on there. They use low energy electrical impulses
to help control any abnormal heart rhythms um sometimes called
arrhythmias rhythmia. Thank you, I had an arrhythmia as a child,
(01:11):
did you. Yep? I had an arrhythmia and a heart murmur.
Wow that's exciting in the bad way. So anyway, so
those can be that your heart is beating either too fast,
too slow, or irregularly. And um, there are more long
words for all of those things, which right now there's
there's a tachycardia there you go, yeah, and breda cardia. Yes,
so those are the too so breda cardias if it's
(01:34):
beating too slowly, and tachycardia is when it's too quickly. Sure,
there's also other conditions that can that can wrap up
into needing a pacemaker a k A. M. Atrial fibrilation
in which the upper chambers of the heart kind of
quiver instead of really contracting. Yeah. So, in order for
you to really understand what we're talking about here, the
(01:56):
heart is divided up into four chambers right right, the
left and right atria, which are the upper chambers, and
the left and right ventricles, which are the lower chambers. Right,
So the upper chamber chambers, the atria, when they when
they contract, they force blood down into the ventricles, which
then when they can try to force it throughout the
rest of the body. And so the combination of these
(02:16):
two contractions are what we think of the heartbeat. The
whole love dub dub is that. Yeah, So that's you know,
the love the atria and the dub the ventricles, so
you know that there's just plenty of room for romance.
But so if if one of these is not working
out correctly, then it's it's a huge problem. Right. So,
(02:36):
if the atria are doing this fibrillation where they are
quivering instead of beating, then it's not providing the right
amount of blood to the ventricles to pump it through
the rest of the body. That's all obviously an issue,
but there's another one too. Write there's also heart block,
in which the electrical signal is slowed or disrupted as
it moves through the heart. So again the problem with
actually the signal reaching the place where it needs to
(02:58):
go so that you have a healthy heartbeat. Right. It's
it's like if the cover on your wire is a
little bit screwy something something to that extent, except the
wires your heart and you need that wire pretty badly. Yeah,
it's it's um. Unless you're the tin man, you pretty
much need one. And these conditions can be caused by
all kinds of disease and other wackiness that could be.
(03:22):
It could be an inherited condition, it can be after
a heart attack, if if a heart attack damages the muscle, right, yeah,
there are injuries that can end up injuring the heart
as a as a result. Yeah. So there's lots of
different ways that this could happen, including things like just
coming out of a surgery that's unrelated to your heart. Sure, absolutely, Okay,
So so what happens when your heart lacks rhythm? You
(03:44):
can no longer do really crazy dances like the electric slide. Okay,
true enough. However, it mostly means that your body might
not be getting enough blood, which would cause a tiredness, lightheadedness,
breathlessness even like fainting, organ damage, and and can potentially
even lead to death if it goes unchecked. Yeah. Yeah,
so we're talking about very serious stuff. Now. A healthy
(04:08):
adult has a heart rate at rest. That's what between
sixty beats permant something like that. Ye ye, so um,
mind's on the high end, which is actually not great.
It means that, honestly, that Jonathan needs to exercise more
so that I have a healthier cardio life. And that's
something that I am working on because it's a concern, right,
I'm getting I'm getting to a certain age um physically
(04:31):
if not mentally or emotionally, so I need to prepare
for that. Generally, slower heartbeat within that range is is ideal.
Um and healthy heartbeats are regular because we have, like
I said earlier, those built in pacemakers. Those are the
sino ar trial I said that right, Yes, which at
the at the at the upper right. Okay, gotcha. So yeah,
(04:53):
so it's this is kind of the signal that lets
the atria no to to contract. So once that signal
goes through to contract the atria, what happens then, Like,
how is it then move onto the ventricle um, it
passes through another node, the atrio ventricular nod. Well, yeah, okay, cool.
(05:13):
So you've got two nodes that are doing this and
they're doing it in a very precise rhythm so that
it creates this contraction that that then pumps the blood
through the rest of the body. All right, And if
that's atrial node isn't working properly, the atrio ventricular node
can take over for it. But it's a it's it's
a weaker force, so it's not as efficient, it's not
(05:34):
as efficient. It's only going to get you up to
about forty beats per minute. Which, um, is why you're
going to encounter that fatigue and breathlessness and stuff like that. Right,
So you'll you'll you'll live, but you'll be getting an
increasingly poor condition. Um. So what do pacemakers do. Pacemakers
can can regulate that they can help slow the rhythm
(05:56):
of a too fast heartbeat or help control and a
regular or too fast form or too slow them. So
they can they can monitor the impulses and override it
or pulses, I guess I should say, and override it
so that it has a more regular heartbeat and keep
someone at an optimal heartbeat range. Right. Sure, And and
(06:16):
if those if those two nodes are not communicating properly,
a pacemaker can help coordinate the electrical signals between them.
I see. So if maybe the cino ore atrial nodes
working just fine, but perhaps the ventricular ones not, then
this could help balance that balance that out right? Sure?
And it does this because okay, So, so a pacemaker
(06:37):
is essentially a very small generator hooked up to a
battery and a computer. Again, very small battery and very
small computer. You have to be implant the sure um
and wires are threaded from the pacemaker through a vein
to the heart. Um. Those wires being tipped with electrodes,
and the electrodes detect your heart's electrical activity and rhythm
(06:59):
and then send that information to the computer which will
monitor them. Um and then uh, it will direct the
generator to fire whenever the signals go go wnkey all right.
So what the computer is doing is looking for any irregularities,
share addresses that right. Um. It can also record these
signals for your doctor to upload and used to adjust
your pacemaker. Um using a wireless device. They don't have
(07:21):
to do surgery on you and check it because they
want to check it about quarterly, so that would be messy.
So this is kind of like a very important version
of a physical activity tracker. It's keeping data on the
activity of your heart and let your doctor know exactly
what's going on right right um. In some cases, that
onboard computer can even be accessed remotely via the interwebs.
(07:41):
So for those of you who are privacy worried about
that kind of thing, the idea that your heart rate
is being monitored remotely maybe not for you. I actually
think I actually think it's super awesome, Like the idea
that that a doctor would have that level of granular
information about a pay stients health and and even be
(08:02):
able to preemptively tell the patient, hey, I'm detecting some
unusual readings here. Could you come in so that we
can make sure that you are in good shape, that
you're in good shape, and that it's not an equipment malfunction.
And you know, obviously that would be incredibly important. And
if it were, you know, I mean there's some some
people have pacemakers who are who are basically doing okay,
(08:23):
it's more precautionary, and but there are other very life
threatening ventricular diseases. Sure, sure, yeah, some models, called great
responsive models will actually adjust to your heart rate to
your changes in activity. Gotcha is like, which again makes sense.
For example, like if you're exerting yourself, then you might
need a different heart rate than if you were at rest.
(08:45):
And uh that's why I remember older pacemakers that was
a real challenge because they would they would keep a
very steady heart rate, which was great, but if you
break into a brisk jug your heart wouldn't be able
to to keep up when the in the computer would
start misfire. Right, So that was a real issue. Sure sure, so, um,
So there are three basic types of pacemakers. You've got
(09:05):
single chamber which carry impulses from the generator to the
heart's right ventricle. Dual chamber which carry those impulses to
the right ventricle and the right atrium um and and
also helped coordinate the timing between the two. Then you've
got bi ventricular which which carry those impulses to the
right atrium and both ventricles helping coordinate all of the signals.
(09:26):
And uh, those are yeah for for as you can imagine,
those those are increasing in seriousness right right, obviously because
you're talking about having to take over more and more
of the hearts activity. There are all there are also
related UM implantable cardio verter cardioverter did I say that right? Yes,
implantable cardioverter defibrillators, which UM use not only those low
(09:47):
energy impulses that a regular pacemaker would use, but also
UM high high energy impulses when necessary to treat very
life threatening So like if you're for example, there I'll
t talk about some of the early ones of this,
but there are some devices that let's say the detects
at your heart that maybe you're going into cardiac arrest.
It can actually deliver a strong enough electrical impulse to possibly,
(10:11):
you know, kickstart your heart going again. So it ends
up being like you know, if you guys have ever
seen any medical procedural, you have obviously seen the person
with which they usually use incorrectly. Yeah, the clear part
is important, by the way, Yes, but now he's doing
poorly from too much electric Um. Yeah, that's ah. This
(10:33):
is something that's sort of an implantable device that does
a similar thing, although it does it in a very
precise way because it's delivering it directly to the heart
and um and and not every pacemaker does this. Um.
They can also, like Jonathan said earlier, be temporary if
you've just had if you've just had a heart attack
or surgery, or perhaps overdosed. While while the patient is
(10:55):
in the hospital with these kinds of issues, they might
have a temporary pacemaker. UM. And of course the permanent ones,
which is more what we've been talking about. I mean,
they wouldn't implant a temporary one, right, Yeah. In fact,
the earliest pacemakers are more like what you would see
with a temporary pacemaker, I mean, far the temporary ones
that we use now are far more sophisticated. Of course,
(11:15):
orders of magnitude more sophisticated. But the ideas that you
would have an external device that would be able, you know,
anyone could monitor and also be able to like a
medical professional would be able to disconnect it once that
was a viable option, and wires would go into you,
which is kind of, you know, depending upon your level
(11:36):
of comfort, a little squeaky, but I'm honestly pretty squeaked
out by the entire wire through a vein thing. Yeah. Well,
just wait until we talk about the history of pacemakers,
because it's going to get really interesting. I'm glad you
took that research. So, in the case of permanent pacemakers,
batteries and generators usually have to be replaced every five
to fifteen years, usually about six or seven. It's really
(11:59):
the battery start running down, and they figure, while we're
performing surgery on you, we might as well change out
the generator to make sure that it doesn't start running
down to right right, So that way, and it actually
decreases the number of surgeries you would need over the lifetime.
Over your lifetime, right sure, yeah, the lifetime of the product,
your lifetime, um and the wires may eventually need to
be replaced as well, but that's that's more case to
(12:22):
case basis. Right now, we talked about in our Electronics
and f A a episode about electromagnetic interference and even
discussed a little bit about how people with pacemakers need
to be careful around devices that emit E m I,
which is pretty much anything that's electrical, right right, And
that's because, like any electrical signal, the impulse is sent
(12:43):
by pacemaker can be disrupted by an electromagnetic field. Yeah. So, now, granted,
in most cases, the instructions you get are pretty pretty
common sense, and stuff like don't don't lay down and
put a laptop computer or a cell phone or for
your heart. Yeah you don't wanna, don't wanna have like
your cell phone in your shirt pocket for example, right right,
(13:05):
You know, avoid brushing up next to strong household appliances,
industrial welders. Don't lay directly against the microwave as you
wait for that sweet sweet popcorn to be delivered to
your hands. You know, keep keep it. Keep your generators.
You're you're larger than your heart generator generator at arms
length that don't use jackhammers kind of that kind of
(13:25):
I never do and everyone thanks me. Yeah, so's and
you know, I mean, things like metal detectors are are
fine if they're you know, I it's you're supposed to
tell security agents like, hey, I've got this pacemaker thing,
please kill me, and and they will know how to
deal with that. Yeah. So it's it's certainly one of
those things that does mean, you know, you have to
take that into account in your lifestyle. Sure, but it's
(13:48):
also development that has, like we said, given a huge
number of people a chance at a healthy life that
otherwise they would not have. So it's it's phenomenal technology.
We'll talk more about how we developed this technology over
years and years of experimentation, some of which enters into
(14:12):
the Frankenstein Mad Scientist realm. And I can't wait to
talk about it. But before we do, let's take a
quick break to thank our sponsor. Now let's get back
to talking about pacemakers. Now, in this particular episode, we
kind of divided up the research of it, so Lauren
ended up looking a lot at how the heart works
(14:34):
and how pacemakers tend to work. If you guys have
ever listened to for thinking, you know that I am
the medical correspondent. Yeah. Yeah, we we make her look
at all the squeaky stuff so we don't have to
because she likes squeaky stuff like um. Although slime, I
would slime is really great, guys. Although I would I
would argue glancing through your notes here for the history
(14:54):
that you actually got the short end of the squick stage.
You know what. This This is why never used the
phrase quick stick. This is a This is entering into
a realm that I actually relish, I because we're talking
about a realm of scientific exploration that definitely goes on
that mad scientist side of the scale. I mean, in
(15:15):
that really cool kind of Victorian era. And this this
is the same era where we saw things like Mary
Shelley's Frankenstein be published, and so that's you know, and
and some of the stuff that was being talked about
and discovered at this time plays into the narrative of
that story, although in a much more kind of literary
way and not a scientific way. But at any rate,
(15:36):
this is when we had people really thinking about electricity
and its effect on the human body, and not just
the human body as it turns out, So you really
need to talk about the history of the pacemaker have
to go all the way back to the mid seventeen hundreds.
That's when it's when people started to experiment with what
they called electro stimulation, using electricity to stimulate muscles. Uh.
(15:58):
And in fact, by this time they were looking at
cardiac electro stimulation, so again using electricity to stimulate the heart.
This was all in animals at the time. Yeah, So
they would find recently dead animals, or they would make
an animal recently dead, and then they would use some
form of electricity to use on electricity source to stimulate
(16:21):
the animal's heart. Electric sources. Yeah, at the time, they
had they had laden jars and voltaic piles peels Actually
you should say voltaic peels. It's it's actually named uh
it's yeah, so peel is French, but it's voltaic peels
or piles if you prefer both of which we were.
(16:41):
I mean our batteries. They are viable batteries, but very dangerous, yeah,
and not particularly strong unless you make huge stacks. Right.
So these are predecessors to what we consider the modern battery.
But that was when there was a lot of experimentation
going on. So they would use them to stimulate the
cardiac nerves and animals in an attempt to resuscitate intact
(17:03):
dead animals and thus, as my notes say, infect the
world with chipmunk zombies. Uh. So, there was a fellow
named Luigi Galvani who was credited with proposing electricity as
the mechanism that causes our muscles to operate. Now here's
the story. Uh, this is very possibly apocryphal, but the
(17:24):
the story the legend that Galvani was working on on
dissecting a little froggy and uh ended up building up
an electrostatic charge and picked up a scalpel and touched
the scalpel to the froggy and it discharged the electro
static charge, which created the spark and made the froggy's
(17:46):
leg twitch. Thus, Galvanni began to think of electricity as
being the means through which our muscles operate. He called
it animal electricity, as opposed to what was being called
heat electricity. So he's he thought that animal electricity was
some sort of electricity trical type of fluid that would
make muscles move. Before then, it was this idea of
(18:09):
laden jars were still based on the principle that electricity
was a fluid isn't that correct? Yeah, yeah, so we're
you know, this is obviously this is the early days
of learning about electricity. So uh. At any rate that
that research led other people to start to tinker around.
One of those was William Hawes h A W. E. S.
(18:30):
He established a society in London called the Humane Society.
But it's not the Humane Society the way we would
think of it in the United States. You hear the
Humane Society and you think, oh, that's an animal rescue.
It's not for adopting dogs and cats. Know, this was
a a group that was dedicated to um well, salvaging
people who appeared to be dead. This was a big
(18:50):
concern at the time a lot of people. You know,
we didn't really have the more precise scientific definitions and
even today's debatable of of what is alive and what
is dead, and we you know, we didn't have heart
rate monitors. It was a morbid time, really, it's what
it was. It was a lot harder to tell and
so there was a huge fear of getting buried alive. Yeah.
So there was also a similar society at the time
(19:13):
in Paris. Paris, Uh, I assume Paris friends and not Paris, Texas.
Eventually the organization would become the Royal Humane Society of London,
and very early on during this society's days, scientists began
to explore electro stimulation as a way of resuscitating people
who appear to have died and maybe who are not
(19:34):
actually dead but could be revived. So se A guy
named Charles Kite writes uh paper titled an Essay upon
the Recovery of the Apparently Dead, which is already my
favorite title of a of a paper since uh, since
more wrote Cramming more components on integrated circuits. Um, I love,
(19:55):
I love, I love these titles. They're better. That's the
best kind of research, really. So, according to the essay,
Ki used electro stimulation to treat a three year old child.
She had fallen out of a window and appeared to
be dead. They had called in an apothecary, who was
unable to do anything. Kite said that it was twenty
minutes before he could arrive to provide some sort of
(20:15):
electro stimulation to the child's heart. He used his He
used essentially electrodes to to deliver a gentle electrical shock
to various parts of the child's body eventually setting on
the thorax or chest really to uh and found that
he got a pulse when he did that, and claimed
that the child woke up was very groggy and uh
(20:37):
and and confused about her surroundings, but that she eventually
made a full recovery. What that tells me is that
this story is probably either exaggerated or there are some
big missing components, Because being dead for twenty minutes is
being dead is dead. You're not You're not You're not
bouncing back from that really, But any rate, it could
(20:59):
be that that no one at the house at the
time could find a heartbeat, right, could have been that
she had a very weak pulse interminute pulse. Even so,
at any rate, that's the story. From seventy six, a
couple of Danish scientists published a paper that was titled
Life Saving Measures for drowning persons and Information of the
best means by which they can be brought back to life,
(21:20):
and that also included electro stimulation of the heart as
a means of saving people. We're gonna jump ahead, so
a lot of people researching this. In eighteen twenty, Dr
de Sanctus in The Medical Guide described the reanimation chair.
I didn't show you a picture of this yet, have
I learned? You're gonna get a chance to see it
(21:42):
on social as well. The chair included bellows which were
meant to force air into the person's lungs, a metallic
tube inserted into the person's esophagus, and a voltaic peel
or pile, depending upon how you want to pronounce it,
attached at one end of the metal tube and the
other end was to an electrode. The electrode was then
to quote regions of the heart, the diaphragm, and the
(22:03):
stomach end quote to cause muscles to contract. If you
look at this thing, or illustrations of this thing, I
should say I haven't seen a picture of what I
don't know if one was ever actually built, but the
illustrations of what it was supposed to look like look
like it came from Hostile or Saw or one of
those movies. It is absolutely terrified to behold. It makes
a dentist chair look absolutely comforting by by comparison, I
(22:30):
look forward to it. Yeah, experiments with electro puncture, this
is where we're really getting into the fun stuff. So
that is that is combining electrical stimulation with acupuncture. So
you've got a needle that you insert into the body
of your your subject and then you shoot electricity through
it to stimulate. Yeah, well animal, it was most animals,
(22:53):
mostly dogs. Actually, uh yeah, I didn't want to dwell
on that too much because I love my doggies. So anyway,
it turned out the early experiments anyway, it turned out
to be i'll use the word failure, So no Frank
and doggies. From this particular early experimentation, however, other people
(23:14):
would start to experiment with using insulated needles that could
deliver an electrical shock to a specific point, the point
of the needle in fact, and that would in fact
be the basis for early pacemakers. Uh. They did discover
that by refining this process that they could stimulate activity
in a heart that was undergoing cardiac arrest. And again
(23:36):
they were using animals, and essentially, in order to experiment,
they would over a neesthetize animals in or to induce
cardiac arrest. So we would see more and more experiments
between eighteen twenty eight and nineteen thirty, which is the
next date I have on my my list, and I I
don't want to be too exhaustive with this, and also
and they get pretty weird. And uh yeah, when you
(23:57):
start talking about getting cadavers from recent executions, it starts
to get pretty grim. So I'm going to I'm gonna
skip over that. We skip over the entire Victorian era.
We skip over Jack the Ripper. Uh, listen to stuff
you missed in history class. They cover all that kind
of stuff. All right, it's n That's when a fellow
by name of Albert S. Hyman develops and patents the
(24:21):
artificial pacemaker. Yeah, so this thing did not look like
a pacemaker as you and I would would recognize if
we were to see one, which are which are large
coin sized. Yeah, they're they're in the Grand Scheme of
Medical Devices. They are tiny. Uh, this one was not tiny.
This was a hand crank. Okay, So you had a
(24:42):
hand crank and it had wires cables essentially that ended
in needles that could be inserted into a person and
by turning the hand crank. There was also a spring
motor inside of it that turned a magneto, which is
a d C current generator. So essentially what you're doing
is you're turning We've talked about inducing electricity to flow
by using moving a conductor through a fluctuating magnetic field.
(25:06):
This is a way of doing that by hand. You
turn the cranks. It's turning it through this magnetic field.
That's inducing electricity to throw to flow rather and that
ends up supplying the electricity needed for the pacemaker. The
insulation needle would deliver the electric charge to the right
atrium of the heart, and by March first, nineteen thirty two,
the pacemaker had been used forty three times with a
successful outcome in fourteen cases, which is about a thirty
(25:29):
three percent success rate, which sounds incredibly low, but then
keep in mind that the essentially this was an absolute
last Yeah, this was the last last ditch effort to
try and revive someone. So it wasn't like this what
These were not the type of pacemakers we've talked about
in our episode where we talked about the things that
you would have in your in your chest for a
(25:50):
prolonged period. This was really meant to revive someone. Yeah,
so this is this is a little different thing. Patient
saved is actually better and zero percent. So, uh, nineteen forties,
that's when they started to Engineers and doctors began to
work on designing defibrillators, which, as we said, can play
(26:10):
a part in some types of pacemakers that you can
find today that are it's kind of a combination device really.
Nine an elderly man who in the literature is called
h N. They don't obviously identify people because it's medical,
but h N suffered heart ailments for several years, had
had heart attacks and other irregularities, and became the recipient
(26:32):
of atronic products. Nine O two M battery operated pacemaker.
This was not an internal unit. It was not an
implant in that sense. They did implant the electrodes so
that they had contact with the heart, but the cables
to the actual device were external, and you would, you know,
have to carry the pacemaker around with you and it
(26:55):
was held outside the body. You know. It could also
detect spont aneas cardiac activity. It had essentially had the
ability to tell if something was going wrong. It wasn't
necessarily able to respond to that dynamically, but it could
at least warn a caregiver that something something was happening. Um,
everything was it was, It worked all right. The one
(27:19):
problem was that the area where the electrodes would go
in through the skin Essentially the needle would go in
through the skin um was prone to minor infections. There
was never like that you would expect from from I mean,
and that's part of the reason why the drive should
create implantable rightmakers exist. And we talked about, you know,
the fact that in our piercing episode or our body
(27:41):
modification episode, we talked about that there is a a
possibility of developing these kind of infections and they may
not be serious, it may not be life threatening, but
they can be problematic. And that was exactly what he
had experienced. It wasn't an infection that was developing into sepsis,
but it was like he would have to have the
area ened regularly so that he could clear out any infection. UH.
(28:03):
In late nineteen sixty two, he underwent surgery for a
pacemaker implant, but he never fully recovered. In fact, he
never recovered from the surgical procedure. He died twenty days
after the surgical procedure, So that was an unfortunate tragedy there,
but he did have lived for several years with this
external pacemaker. In nineteen sixty doctor Robert Rubio implant a
(28:26):
pacemaker into a female patient and that pacemaker was fifty
two point five millimeters in diameter, which is about two
inches uh seventeen point five millimeters thick, which is about
point seven inches, so just over half an inch, and
waged sixty four point three grams or two point three
ounces or less than a quarter of a pound. Now
that one got power from two rechargeable nickel cadmium batteries
(28:48):
which were charged through induction from an external flexible coil
placed on the skin over the pacemaker. So this is
the way some pacemakers are recharged today using a similar approach,
although it's usually radio frequencies. But what we're talking about
wireless power here right where you can induce this charging
through um again, your your cree. It's all about magnetic
(29:09):
fields and electricity is really what we get down to.
So you would have to place this flexible coil directly
over your heart in order to recharge the pacemaker, or
really directly over the pacemaker wherever the pacemaker was located,
wherever the you know, the battery was uh. The stimulated
electrode for this was a platinum disk, so it was
an expensive piece of medical technology. But sadly the patient
(29:32):
died nine and a half months after the surgery, because
she did develop an infection which turned into sepsis after
the surgery. So the pacemaker was working, but the it
was a side effect of the surgery. She unfortunately perished
from that. So early implannable pacemakers varied widely and how
long they could operate before requiring a recharge. So one
(29:53):
of them would only go like eight hours and then
you have to recharge it. That's pretty yeah, that's pretty yeah.
But there were others that could go weeks or even
months before a recharge, even in the early days in
the sixties. Uh this this also, I mean still today,
how much how much your your pacemaker is actually needing
(30:14):
to to create a charge will make your battery life
very right. So in other words, in other words, if
if it's only occasionally having to intervene, then you're recharging,
may you may not need to recharge it as frequently
as someone where it's more active more frequently. Um So,
in the nineteen sixties, that's when we started to see
the cardiac stimulator defibrillators, which we kind of talked about.
(30:37):
It's under called something else today, but same sort of
idea that the device that can uh detect when a
heart beat stops and then try to restart it with
a controlled electrical burst to the heart. Uh. The early
versions of that were also not implantable. They were external
as well. But now we've got implantable ones that are
(30:57):
incorporated with sort of pacemaker technology. UM. Now, as far
as the future goes, because from the nineteen sixties on
to the present, it was really refining that process. It's
just that miniaturization and in electrical stimulation yep, yep, making
sure that we were getting more precise and smaller. Those
are really the trends. So anything from nineteen sixties on
(31:19):
is more about refining that that design. Uh. Talking about
the future, miniaturization is going to continue to be a factor.
In fact, there are companies right now that are trying
to create pacemakers that are about the size of a pill.
So that tiny. So the reason why you want this
is not just because it it takes up less space
in the patient. Really, it's because the surgical procedures become
(31:40):
less invasive. It's less damaged to the body, less chance
for infection, UH, makes it less chance for something to
go wrong, because you're it's just it's just a smaller
surgical procedure. So that's really where we're seeing the future
come in as far as Pacemakers are concerned. And now
that kind of wraps up our our episode. We were
(32:01):
really interested in this topic. It was kind of it's
it's always fun for us to take a specific technology
and explain how it works and really where it came from.
We love doing that. I mean we obviously we love
doing things like covering various companies as well. Uh, not
to mention the fact that we have covered many, many,
many personalities in technology. But if you guys want to
hear us do more of this sort of thing, then
(32:24):
I recommend you right in and let us know. So
send us a message. You can write us an email
that addresses tech stuff at Discovery dot com, where you
can find us on Tumbler or Facebook or Twitter with
the handle text stuff hs W and who knows, you know,
we may take your your suggestion. This suggestion, by the way,
(32:47):
came to us from a listener right Facebook, from Peter. So, Peter,
I hope you enjoyed this episode about Pacemakers. I hope
you were not asking about Jerry and the Pacemakers, because
that's a band and they did very Across the Mercy,
which is a great song but not what we covered.
So hopefully we met your expectations. Let us know if
(33:07):
we didn't. And guys, that wraps this up. We will
talk to you again really soon for more on this
and thousands of other topics. Is it how stuff works
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