September 4, 2020 • 32 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):
Welcome to tech Stuff, a production from I Heart Radio.
Hey there, and welcome to tech Stuff. I'm your host,
Jonathan Strickland. I'm an executive producer with I Heart Radio
and I love all things tech. And it is time
once again, my friends, for a classic episode, and this
(00:26):
one published on October ninth, two thousand thirteen. It is
titled Pacemakers Got the Beat. This just reminds me of
how much work I put into making really really cringe
e titles back in the day. I still do it occasionally,
but man, I was really on a role in two
thousand thirteen. Let's listen in to this classic episode. What
(00:48):
do you mean electrical impulses? That's that's how the heart works.
There's crazy there. We we we have natural pacemakers, and
sometimes they work less well than others, but so yeah,
so so. Pacemakers are are small divice is that are
implanted nearish the heart in the general just air, cavity, shoulder,
abdomen somewhere on there. They use low energy electrical impulses
(01:09):
to help control any abnormal heart rhythms um sometimes called
rhythmias rhythmia. Thank you. I had an arrhythmia as a child,
did you Yeah, I had a 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
(01:30):
words for all of those things, which right, there's there's
a tachycardia there you go, yeah, and breda cardia. Yes,
so those are the too so brada cardias if it's
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. Atrial fibrilation in
(01:54):
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 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
(02:17):
then when they can try to force it throughout the
rest of the body. And so the combination of these
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 if one of these is not
(02:38):
working out correctly, then it's huge problem. Right. So, 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 to write. There's also heart block, in
which the electrical signal is slowed or disrupted as it
(02:58):
moves through the heart. So again problem with actually the
signal reaching the place where it needs to 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, and
it's it's um unless you're the tin man, you pretty
(03:21):
much need one. And these conditions can be caused by
all kinds of disease and other wackiness that could be.
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
(03:41):
coming out of a surgery that's unrelated to your heart. Sure, absolutely, Okay, So,
so what happens when your heart lacks rhythm? You 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
(04:06):
even lead to death if it goes unchecked. Yeah. Yeah,
so we're talking about very serious stuff. Now. A healthy
adult has a heart rate at rest, that's what between
sixty beats permant something like that. Yep, yep. So um,
mind's on the high end, which is actually not great.
It means that, honestly, that Jonathan needs to exercise more
(04:28):
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,
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
(04:50):
the sino artrial I said that, right, Yes, the nodes
which the at the at the upper right. Okay, gotcha.
So yeah, 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
(05:13):
passes through another node, the atrio ventricular nod. Well, yeah, okay, cool,
So you 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. Right, And if that's
you know, atrial node isn't working properly, the atrio ventricular
(05:34):
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 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. Right, Um, So what
(05:55):
do pacemakers do. Pacemakers can can regulate that they can
help slow the rhythm of a too fast heartbeat or
help control and a regular too fast rhythm or too
slow rhythm. 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
(06:17):
heartbeat and keep someone at an optimal heartbeat range. Right. Sure,
And and 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 sino ore
atrial nodes working just fine, but perhaps the ventricular ones not,
then this could help balance that balance that out right? Sure?
(06:40):
And it does this because okay, So, so a pacemaker
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 implanted the implant, sure UM,
and wires are threaded from the pacemaker through a vein
to the heart. UM. Those wires being tipped with electrodes,
(07:01):
and the electrodes detect your heart's electrical activity and rhythm
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 wonkey, all right.
So what the computer is doing is looking for any irregularities,
addresses that right right UM. It can also record these
(07:22):
signals for your doctor to upload and used to adjust
your pacemaker UM using a wireless device. They don't have
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 letting your doctor know exactly
what's going on right right um. In some cases, that
(07:43):
onboard computer can even be accessed remotely via the interwebs.
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
(08:04):
information about a patient's health and and even be 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. 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
(08:26):
have pacemakers who are who are basically doing okay, 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
(08:48):
need a different heart rate than if you were at rest.
And h 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 ask jog, your heart wouldn't be able
to keep up when the and the computer would start misfiring.
So that was a real issue. Sure, sure, So so
(09:09):
there are three basic types of pacemakers. You've got 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. And then you've
got bi ventricular which which carry those impulses to the
right atrium and both ventricles helping coordinate all of the signals.
(09:32):
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. They are all they're also related
UM implantable cardio verter cardioverter Did I say that right? Yes,
implantable cardioverter defibrillators which UM use not only those low
(09:53):
end energy impulses that a regular pacemaker would use, but
also UM higher high energy impulses when necessary to treat
very life threatening So like if you're for example, there
I'll talk about some of the early ones of this.
But there are some devices that let's say the detects
that your heart that maybe you're going into cardiac arrest,
it can actually deliver a strong enough electrical impulse to possibly,
(10:17):
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
(10:39):
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 attacker,
surgery or perhaps overdose. While while the patient is in
(11:01):
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,
(11:21):
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
(11:42):
of comfort, a little squeaky, but I'm honestly pretty squeaked
out by the entire wire through a vein thing. Yeah, well,
just wait till we talk about the history of pacemakers,
because that's going to get really interesting. I'm glad you
took that research. So, in the case of permanent pacemakers,
batteries and generated as usually have to be replaced every
five to fifteen years, usually about six or seven. It's
(12:04):
really the batteries 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
(12:27):
more case to 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
(12:49):
sent 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. Yeah, 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
(13:09):
pocket for example, right right? 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 arm's length that don't use jackhammers
(13:31):
kind of that kind of thing, never do and everyone
thanks me. Yeah, So it'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 don't 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
(13:52):
your lifestyle. Sure, but it's also development that has, like
we said, given on a huge number of people a
chance at a healthy life that otherwise they would not have. Hey, guys,
it's Jonathan from twenty. We're going to take a break
on this episode about pacemakers to thank our sponsors, but
(14:15):
we'll be right back 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 and how
(14:37):
pacemakers tend to work. If you guys have ever listened
to for thinking, you know, that I am the medical correspondent. 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 that you actually got the short
(14:59):
end of the squick stap. You know what. This This
is why I 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 that really cool kind
of Victorian era. And this this is the same era
(15:20):
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, this is when we
had people really thinking about electricity and its effect on
(15:43):
the human body, and not just the human body as
it turns out. So you really to talk about the
history of the pacemaker, have to go all the way
back to the mid seventeen hundreds. That's when when people
started to experiment with what they called electro stimulation, using
electricity to stimulate muscle. Uh. And in fact, by this
time they were looking at cardiac electro stimulation, so again
(16:05):
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 an electricity source to stimulate the animal's heart. Electric sources. Yeah,
at the time, they had they had laden jars and
(16:28):
voltaic piles peels actually you should say voltaic peels. It's
it's actually named uh It's ok. Yeah, so peel is French,
but it's voltaic peels or piles if you prefer both
of which we were. I mean our batteries. They are
viable batteries, but very dangerous, yeah, and not particularly strong
(16:49):
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 to stimulate the cardiac nerves and animals
in an attempt to resuscitate intact dead animals and thus,
as my notes say, infect the world with chipmunk zombies. Uh. So,
(17:12):
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 the story the legend that Galvani
was working on on dissecting a little froggy and uh
(17:36):
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 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
(17:58):
what was being called heat electricity. So he's he thought
that animal electricity was some sort of electricity trickal type
of fluid that would make muscles move. Before then, it
was this idea of 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 at any rate
(18:22):
that that research led other people to start to tinker around.
One of those was William Hawes h A W. E. S.
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 that's an animal rescue. It's
not for adopting dogs and cats. Know, this was a
(18:45):
a a group that was dedicated to um well, salvaging
people who appeared to be dead. This was a big
concern at the time a lot of people. You know,
we didn't really have the more precise scientific definitions and
even today this 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 was.
(19:06):
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 in Paris. Paris, uh,
I assume Paris friends, 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
(19:30):
electro stimulation as a way of resuscitating people who appear
to have died and maybe who are not 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
(19:52):
Cramming more components on integrated circuits. Um, I love, I love,
I love these titles. They're better. That's the best kind
of research. Drillly so. According to the essay, Kite 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
(20:15):
he could arrive to provide some sort of 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 settling on the thorax
or chest really to uh and found that he got
a pulse when he did that, and claimed that the
(20:36):
child woke up was very groggy and uh 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. It
is dead. You're not you're not bouncing back from that, really,
(21:00):
But any rate, it could 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 and See. 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, and that also included electric
(21:23):
stimulation of the heart as a means of saving people.
We're gonna jump ahead, so there 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 an You're
gonna get a chance to see it. Link it on
(21:44):
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 touched to
quote regions of the heart, the diaphragm, and the stomach
(22:06):
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.
Is absolutely terrified to behold. It makes a dentist chair
(22:26):
look absolutely comforting. By by comparison, it's Jonathan from Again.
We're going to take another quick break from this classic episode,
but we will return shortly. Experiments with electoral puncture. This
(22:46):
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 Yeah, well animal probably it was mostly animals,
mostly dogs. Actually, uh yeah, I didn't want to dwell
(23:09):
on that too much because I'm 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 would start to experiment with using insulated needles
that could deliver an electrical shock to specific to a
(23:32):
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 they were using animals, and essentially, in order
to experiment, they would over anesthetize animals in or to
(23:53):
induce cardiac arrest. So we would see more and more
experiments between eighteen twenty eight and nineteen thirty which is
the next day I have on my my list, and
I want to be too exhaustive with this, and also
and they get pretty weird, and uh yeah, when you
start talking about getting cadavers from recent executions, it starts
(24:14):
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 that's when a fellow by
the name of Albert S. Hyman develops and patents the
artificial pacemaker. Yeah, so this thing did not look like
(24:38):
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. This one was not tiny.
This was a hand crank. Okay, so you had a
hand crank and it had wires cables essentially that ended
in needles that could be inserted in to a person
(25:01):
and by turning the hand crank. There was also a
spring motor inside of it that turned a magneto, which
is a DC 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.
This is a way of doing that by hand. You
turn the crank, it's turning it through this magnetic field,
(25:22):
and 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 three pc success rate, which sounds incredibly low,
(25:44):
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 prolonged period. This was really meant to revive someone. Yeah,
(26:06):
so this is this is a little different thing. Patients
saved is actually better than zero percent. So nineteen forties.
That's when they started to engineers and doctors began to
work on designing defibrillators, which, as we said, can play
a part in some types of pacemakers that you can
find today that are it's kind of a combination device. Really.
(26:29):
Ninety 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
of Atronic products. Nine O two M battery operated pacemaker.
(26:50):
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
was held outside the body. You know. It could also
(27:11):
detect spontaneous 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 just something something was happening. Um,
everything was it was, yeah, it worked all right. The
one problem was that the area where the electrodes would
(27:34):
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's what you would expect from
from I mean, and that's part of the reason why
the drive to create implantable racemakers exist. And we talked about,
you know the fact that in our piercing episode or
our body modification episode, we talked about that there is
(27:55):
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 cleaned regularly so that he could clear
out any infection. UH. In late nineteen sixty two, he
(28:17):
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
(28:37):
Robert Rubio implanted a pacemaker into a female patient, and
that pacemaker was fifty two point five millimeters in diameter,
which is about two inches seventeen point five millimeters thick,
which is about points seven inches, so just over half
an inch, and wade 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
(28:57):
nickel cadmium batteries 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 create.
(29:19):
It's all about magnetic 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.
The stimulated electrode for this was a platinum disk so
it was an expensive piece of medical technology. But sadly,
(29:43):
the patient 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 really implanable pacemakers varied widely
and how long they could operate before requiring a recharge.
(30:05):
So one 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 to to create a charge will make
(30:29):
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, 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 it's under a called something else today, but
(30:51):
same sort of idea that the device that can UH
detect when a heart beat stops and then try to
restart it with a trolled electrical burst to the heart. Uh.
The early versions of that we're also not implantable. They
were external as well, but now we've got implantable ones
that are incorporated with sort of pacemaker technology. UM. Now,
(31:13):
as far as the future goes, because from the nineteen
sixties on to the present, it was really refining that process.
It's just miniaturization and improvements in electrical stimulation ye yep,
making sure that we were getting more precise and smaller.
Those are really the trends. So anything from nineteen sixties
on is more about refining that that design. Uh. Talking
(31:35):
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. They 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 less invasive, it's less damaged to the body,
(31:55):
less chance for infection, Uh, makes it less chance for
some thing 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 that wraps up this classic episode of tech Stuff.
Hope you guys enjoyed it. If you have any suggestions
for future topics that we should cover on the show,
(32:18):
reach out on Twitter or Facebook. The handle it both
of those is text Stuff h s W and I'll
talk to you again really soon. Y. Text Stuff is
an I Heart Radio production. For more podcasts from my
Heart Radio, visit the i Heart Radio app, Apple Podcasts,
(32:40):
or wherever you listen to your favorite shows.
Welcome to tech Stuff, a production from I Heart Radio.
Hey there, and welcome to tech Stuff. I'm your host,
Jonathan Strickland. I'm an executive producer with I Heart Radio
and I love all things tech. And it is time
once again, my friends, for a classic episode, and this
(00:26):
one published on October ninth, two thousand thirteen. It is
titled Pacemakers Got the Beat. This just reminds me of
how much work I put into making really really cringe
e titles back in the day. I still do it occasionally,
but man, I was really on a role in two
thousand thirteen. Let's listen in to this classic episode. What
(00:48):
do you mean electrical impulses? That's that's how the heart works.
There's crazy there. We we we have natural pacemakers, and
sometimes they work less well than others, but so yeah,
so so. Pacemakers are are small divice is that are
implanted nearish the heart in the general just air, cavity, shoulder,
abdomen somewhere on there. They use low energy electrical impulses
(01:09):
to help control any abnormal heart rhythms um sometimes called
rhythmias rhythmia. Thank you. I had an arrhythmia as a child,
did you Yeah, I had a 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
(01:30):
words for all of those things, which right, there's there's
a tachycardia there you go, yeah, and breda cardia. Yes,
so those are the too so brada cardias if it's
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. Atrial fibrilation in
(01:54):
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 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
(02:17):
then when they can try to force it throughout the
rest of the body. And so the combination of these
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 if one of these is not
(02:38):
working out correctly, then it's huge problem. Right. So, 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 to write. There's also heart block, in
which the electrical signal is slowed or disrupted as it
(02:58):
moves through the heart. So again problem with actually the
signal reaching the place where it needs to 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, and
it's it's um unless you're the tin man, you pretty
(03:21):
much need one. And these conditions can be caused by
all kinds of disease and other wackiness that could be.
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
(03:41):
coming out of a surgery that's unrelated to your heart. Sure, absolutely, Okay, So,
so what happens when your heart lacks rhythm? You 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
(04:06):
even lead to death if it goes unchecked. Yeah. Yeah,
so we're talking about very serious stuff. Now. A healthy
adult has a heart rate at rest, that's what between
sixty beats permant something like that. Yep, yep. So um,
mind's on the high end, which is actually not great.
It means that, honestly, that Jonathan needs to exercise more
(04:28):
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,
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
(04:50):
the sino artrial I said that, right, Yes, the nodes
which the at the at the upper right. Okay, gotcha.
So yeah, 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
(05:13):
passes through another node, the atrio ventricular nod. Well, yeah, okay, cool,
So you 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. Right, And if that's
you know, atrial node isn't working properly, the atrio ventricular
(05:34):
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 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. Right, Um, So what
(05:55):
do pacemakers do. Pacemakers can can regulate that they can
help slow the rhythm of a too fast heartbeat or
help control and a regular too fast rhythm or too
slow rhythm. 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
(06:17):
heartbeat and keep someone at an optimal heartbeat range. Right. Sure,
And and 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 sino ore
atrial nodes working just fine, but perhaps the ventricular ones not,
then this could help balance that balance that out right? Sure?
(06:40):
And it does this because okay, So, so a pacemaker
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 implanted the implant, sure UM,
and wires are threaded from the pacemaker through a vein
to the heart. UM. Those wires being tipped with electrodes,
(07:01):
and the electrodes detect your heart's electrical activity and rhythm
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 wonkey, all right.
So what the computer is doing is looking for any irregularities,
addresses that right right UM. It can also record these
(07:22):
signals for your doctor to upload and used to adjust
your pacemaker UM using a wireless device. They don't have
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 letting your doctor know exactly
what's going on right right um. In some cases, that
(07:43):
onboard computer can even be accessed remotely via the interwebs.
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
(08:04):
information about a patient's health and and even be 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. 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
(08:26):
have pacemakers who are who are basically doing okay, 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
(08:48):
need a different heart rate than if you were at rest.
And h 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 ask jog, your heart wouldn't be able
to keep up when the and the computer would start misfiring.
So that was a real issue. Sure, sure, So so
(09:09):
there are three basic types of pacemakers. You've got 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. And then you've
got bi ventricular which which carry those impulses to the
right atrium and both ventricles helping coordinate all of the signals.
(09:32):
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. They are all they're also related
UM implantable cardio verter cardioverter Did I say that right? Yes,
implantable cardioverter defibrillators which UM use not only those low
(09:53):
end energy impulses that a regular pacemaker would use, but
also UM higher high energy impulses when necessary to treat
very life threatening So like if you're for example, there
I'll talk about some of the early ones of this.
But there are some devices that let's say the detects
that your heart that maybe you're going into cardiac arrest,
it can actually deliver a strong enough electrical impulse to possibly,
(10:17):
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
(10:39):
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 attacker,
surgery or perhaps overdose. While while the patient is in
(11:01):
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,
(11:21):
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
(11:42):
of comfort, a little squeaky, but I'm honestly pretty squeaked
out by the entire wire through a vein thing. Yeah, well,
just wait till we talk about the history of pacemakers,
because that's going to get really interesting. I'm glad you
took that research. So, in the case of permanent pacemakers,
batteries and generated as usually have to be replaced every
five to fifteen years, usually about six or seven. It's
(12:04):
really the batteries 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
(12:27):
more case to 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
(12:49):
sent 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. Yeah, 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
(13:09):
pocket for example, right right? 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 arm's length that don't use jackhammers
(13:31):
kind of that kind of thing, never do and everyone
thanks me. Yeah, So it'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 don't 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
(13:52):
your lifestyle. Sure, but it's also development that has, like
we said, given on a huge number of people a
chance at a healthy life that otherwise they would not have. Hey, guys,
it's Jonathan from twenty. We're going to take a break
on this episode about pacemakers to thank our sponsors, but
(14:15):
we'll be right back 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 and how
(14:37):
pacemakers tend to work. If you guys have ever listened
to for thinking, you know, that I am the medical correspondent. 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 that you actually got the short
(14:59):
end of the squick stap. You know what. This This
is why I 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 that really cool kind
of Victorian era. And this this is the same era
(15:20):
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, this is when we
had people really thinking about electricity and its effect on
(15:43):
the human body, and not just the human body as
it turns out. So you really to talk about the
history of the pacemaker, have to go all the way
back to the mid seventeen hundreds. That's when when people
started to experiment with what they called electro stimulation, using
electricity to stimulate muscle. Uh. And in fact, by this
time they were looking at cardiac electro stimulation, so again
(16:05):
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 an electricity source to stimulate the animal's heart. Electric sources. Yeah,
at the time, they had they had laden jars and
(16:28):
voltaic piles peels actually you should say voltaic peels. It's
it's actually named uh It's ok. Yeah, so peel is French,
but it's voltaic peels or piles if you prefer both
of which we were. I mean our batteries. They are
viable batteries, but very dangerous, yeah, and not particularly strong
(16:49):
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 to stimulate the cardiac nerves and animals
in an attempt to resuscitate intact dead animals and thus,
as my notes say, infect the world with chipmunk zombies. Uh. So,
(17:12):
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 the story the legend that Galvani
was working on on dissecting a little froggy and uh
(17:36):
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 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
(17:58):
what was being called heat electricity. So he's he thought
that animal electricity was some sort of electricity trickal type
of fluid that would make muscles move. Before then, it
was this idea of 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 at any rate
(18:22):
that that research led other people to start to tinker around.
One of those was William Hawes h A W. E. S.
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 that's an animal rescue. It's
not for adopting dogs and cats. Know, this was a
(18:45):
a a group that was dedicated to um well, salvaging
people who appeared to be dead. This was a big
concern at the time a lot of people. You know,
we didn't really have the more precise scientific definitions and
even today this 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 was.
(19:06):
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 in Paris. Paris, uh,
I assume Paris friends, 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
(19:30):
electro stimulation as a way of resuscitating people who appear
to have died and maybe who are not 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
(19:52):
Cramming more components on integrated circuits. Um, I love, I love,
I love these titles. They're better. That's the best kind
of research. Drillly so. According to the essay, Kite 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
(20:15):
he could arrive to provide some sort of 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 settling on the thorax
or chest really to uh and found that he got
a pulse when he did that, and claimed that the
(20:36):
child woke up was very groggy and uh 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. It
is dead. You're not you're not bouncing back from that, really,
(21:00):
But any rate, it could 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 and See. 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, and that also included electric
(21:23):
stimulation of the heart as a means of saving people.
We're gonna jump ahead, so there 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 an You're
gonna get a chance to see it. Link it on
(21:44):
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 touched to
quote regions of the heart, the diaphragm, and the stomach
(22:06):
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.
Is absolutely terrified to behold. It makes a dentist chair
(22:26):
look absolutely comforting. By by comparison, it's Jonathan from Again.
We're going to take another quick break from this classic episode,
but we will return shortly. Experiments with electoral puncture. This
(22:46):
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 Yeah, well animal probably it was mostly animals,
mostly dogs. Actually, uh yeah, I didn't want to dwell
(23:09):
on that too much because I'm 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 would start to experiment with using insulated needles
that could deliver an electrical shock to specific to a
(23:32):
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 they were using animals, and essentially, in order
to experiment, they would over anesthetize animals in or to
(23:53):
induce cardiac arrest. So we would see more and more
experiments between eighteen twenty eight and nineteen thirty which is
the next day I have on my my list, and
I want to be too exhaustive with this, and also
and they get pretty weird, and uh yeah, when you
start talking about getting cadavers from recent executions, it starts
(24:14):
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 that's when a fellow by
the name of Albert S. Hyman develops and patents the
artificial pacemaker. Yeah, so this thing did not look like
(24:38):
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. This one was not tiny.
This was a hand crank. Okay, so you had a
hand crank and it had wires cables essentially that ended
in needles that could be inserted in to a person
(25:01):
and by turning the hand crank. There was also a
spring motor inside of it that turned a magneto, which
is a DC 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.
This is a way of doing that by hand. You
turn the crank, it's turning it through this magnetic field,
(25:22):
and 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 three pc success rate, which sounds incredibly low,
(25:44):
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 prolonged period. This was really meant to revive someone. Yeah,
(26:06):
so this is this is a little different thing. Patients
saved is actually better than zero percent. So nineteen forties.
That's when they started to engineers and doctors began to
work on designing defibrillators, which, as we said, can play
a part in some types of pacemakers that you can
find today that are it's kind of a combination device. Really.
(26:29):
Ninety 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
of Atronic products. Nine O two M battery operated pacemaker.
(26:50):
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
was held outside the body. You know. It could also
(27:11):
detect spontaneous 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 just something something was happening. Um,
everything was it was, yeah, it worked all right. The
one problem was that the area where the electrodes would
(27:34):
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's what you would expect from
from I mean, and that's part of the reason why
the drive to create implantable racemakers exist. And we talked about,
you know the fact that in our piercing episode or
our body modification episode, we talked about that there is
(27:55):
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 cleaned regularly so that he could clear
out any infection. UH. In late nineteen sixty two, he
(28:17):
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
(28:37):
Robert Rubio implanted a pacemaker into a female patient, and
that pacemaker was fifty two point five millimeters in diameter,
which is about two inches seventeen point five millimeters thick,
which is about points seven inches, so just over half
an inch, and wade 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
(28:57):
nickel cadmium batteries 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 create.
(29:19):
It's all about magnetic 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.
The stimulated electrode for this was a platinum disk so
it was an expensive piece of medical technology. But sadly,
(29:43):
the patient 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 really implanable pacemakers varied widely
and how long they could operate before requiring a recharge.
(30:05):
So one 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 to to create a charge will make
(30:29):
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, 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 it's under a called something else today, but
(30:51):
same sort of idea that the device that can UH
detect when a heart beat stops and then try to
restart it with a trolled electrical burst to the heart. Uh.
The early versions of that we're also not implantable. They
were external as well, but now we've got implantable ones
that are incorporated with sort of pacemaker technology. UM. Now,
(31:13):
as far as the future goes, because from the nineteen
sixties on to the present, it was really refining that process.
It's just miniaturization and improvements in electrical stimulation ye yep,
making sure that we were getting more precise and smaller.
Those are really the trends. So anything from nineteen sixties
on is more about refining that that design. Uh. Talking
(31:35):
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. They 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 less invasive, it's less damaged to the body,
(31:55):
less chance for infection, Uh, makes it less chance for
some thing 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 that wraps up this classic episode of tech Stuff.
Hope you guys enjoyed it. If you have any suggestions
for future topics that we should cover on the show,
(32:18):
reach out on Twitter or Facebook. The handle it both
of those is text Stuff h s W and I'll
talk to you again really soon. Y. Text Stuff is
an I Heart Radio production. For more podcasts from my
Heart Radio, visit the i Heart Radio app, Apple Podcasts,
(32:40):
or wherever you listen to your favorite shows.
TechStuff News
Hosts And Creators
Oz Woloshyn
Karah Preiss
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