The Evolution of the Cardiac Pacemaker: A Century of Innovation

1889: John McWilliam demonstrated the use of applied electrical current directly to the ventricles after stimulating the vagus nerve to depress cardiac rhythms. Multiple shocks improved blood pressure by increasing how much blood was pumped following each shock.
1928: Mark Lidwill successfully applied shocks to the heart of a stillborn infant via needle insertion and was able to fully resuscitate the infant after 10 minutes of stimulation.
1932: Albert Hyman created a hand-crank motor that applied current to the sinus node of the right atrium, but due to the danger of placing a needle in the heart, manufacturing of the device did not progress.
1950: John Callaghan and Wilfred Bigelow improved on Hyman’s design and successfully demonstrated its use on canines.
1952: Paul Zoll further improved the design and was able to maintain the cardiac rhythm of a 65-year-old male with recurring cardiac arrest, who survived for an additional 6 months.
Both Zoll’s version and the earlier models were constrained by the same factors: direct stimulation of the heart via needles, a large and clunky device, and the requirement to be plugged in for AC power.
1957: Walton Lillehei and Earl Bakken collaborated to develop a wearable battery with leads that entered the chest, allowing the patients to be ambulatory. This was quickly used to manage heart block after surgery.
1958: Ake Senning and Rune Elmqvist created a fully implantable version that could be charged externally via an induction coil. The first patient to receive it, Arne Larsson, had it failed after 3 hours. Larsson received 26 pacemakers over the remainder of his life.
1959: Seymour Furman developed the technique of passing a lead through a vein to the right ventricle (transvenous pacing) during surgery, removing the needle constraint.
1960: William Chardack and Andrew Gage collaborated with an engineer, Wilson Greatbatch, who worked to solve the battery issue. This resulted in a patient living for an additional 18 months. Greatbatch licensed the design to Medtronic (co-founded by Earl Bakken) and continued improving it until he developed a five-year lithium battery by 1972. Cardiac Pacemakers Inc. created a method to seal it within a titanium alloy case.
1974: The FDA initiated a pacemaker registry to collect information on pacemaker and lead performance, failures, removals, and patterns of use. The registry ultimately contributed to long-term surveillance of implanted cardiac devices. The Bilitch Report, published in 1994, summarized nearly two decades of registry data.
1982: Anthony Rickards developed a physiologically adaptive version that could use sensors and microprocessors to modulate the heart rate to usage needs.
1988: Raul Chirife developed a more advanced version of Rickards’ invention that used a hemodynamic sensor to monitor blood flow.
1990s: Pacemakers commonly included single-chamber systems, which generally paced the right ventricle, and dual-chamber systems, which coordinated pacing between the right atrium and right ventricle. During this period, use of dual-chamber systems increased substantially.
Early 2000s: Biventricular pacing, also known as cardiac resynchronization therapy (CRT), emerged as another pacing strategy for selected patients with heart failure and abnormal ventricular conduction. It uses pacing sites in both ventricles to help synchronize ventricular contraction.
Modern versions: Advances in electronics, miniaturization, batteries and sensing have allowed pacemakers to incorporate more sophisticated monitoring and rate-adaptation capabilities.
Today: Major manufacturers of pacemakers in the U.S. include Medtronic, Abbott, and Boston Scientific, along with other manufacturers such as BIOTRONIK and MicroPort.

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