(Circulation. 1998;97:1978-1991.)
© 1998 American Heart Association, Inc.
Cardiac Pacing, 1960–1985
A Quarter Century of Medical and Industrial Innovation
Kirk Jeffrey, PhD;
; Victor Parsonnet, MD
From Carleton College, Northfield, Minn (K.J.), and the Newark (NJ) Beth
Israel Medical Center (V.P.).
Correspondence to Kirk Jeffrey, PhD, Professor of History, Carleton College, One North College Street, Northfield, MN 55057.
Key Words: pacing • pacemakers • electrical stimulation • arrhythmia
Eugene
Braunwald1 has compared the intense activity in
cardiology between 1950 and 1990 to the
systolic phase of the heartbeat. In the present paper, we
discuss one important aspect of the broader transformation of
cardiovascular medicine: the development of pacemaker
technology to treat bradyarrhythmias. (Tachypacing and the
implantable cardioverter-defibrillator, innovations of the 1980s, are
beyond the scope of this discussion.) We are particularly interested in
the sources of innovation in pacing, a field known for rapid shifts in
hardware and techniques. After the first pacemaker implants (1958 and
1960), physicians guided technological change in pacing for about a
decade. Beginning in the 1970s, pacemaker manufacturers supplanted
physicians as the dominant influence on the technology of the
field.
A new invention ordinarily goes through a period of uncertainty when it
is not clear which of several variants will succeed. Eventually a
dominant design, a standard version of the technology
"synthesized from individual technological innovations introduced
independently in prior product variants," may
emerge.2 By the late 1960s, physician-innovators
had created a dominant design in pacing; we call it "the reliable
pacemaker." After 1970, device manufacturing firms introduced further
innovations, leading to a new dominant design that we will call "the
multifunctional pacemaker."
We will use common descriptive labels to refer to specific pacing modes
(noncompetitive, AV sequential, etc). At the request of the
Inter-Society Commission for Heart Disease Resources, a Pacemaker Study
Group (Drs S. Furman, N.P.D. Smyth, and Parsonnet) proposed a standard
three-position (later five-position) pacemaker code that has now . . . [Full Text of this Article]
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