Early Cardiac Pacing

Given that bradycardia leads to syncope, and that electricity can be used to pace the heart, Giovani Aldini reasoned that electrical pacing of the heart could alleviate syncope. In 1804 he alleviated syncope by pacing the heart. He went on to recommend a combination of pacing and respiration to revive people.

In 1853 chloroform anesthesia was used during Queen Victoria's delivery of children, and the use of the anesthetic grew. Although, it was an advance, one major side effect of its use was cardiac arrest. A solution was needed to prevent this fatal side effect. Building on previous observations, F. Steiner in Germany was the first to perform needle electrode pacing in animals after chloroform induced cardiac arrest.9 Direct current pulses were delivered via a 13-cm long, 1-mm thick needle with a metronome as a regulator. Steiner paced a woman who had suffered cardiac arrest by placing a needle electrode inserted to her ventricular apex.10 This emergency temporary pacing may have saved her life. Later Greene in the United Kingdom paced the apex from a direct current battery and also paced the phrenic nerve to provide cardiac and respiratory support.9

In 1882 a Prussian woman named Catharina Serafin came to the attention of Hugo von Ziemssen. Serafin had a chest wall tumor that was removed, leaving her heart exposed under a thin layer of skin. This allowed for a series of important experiments (although likely unethical by today's standards). Using electrical stimulation on the ventricles, he was able to pace the ventricle and achieve a pulse between 120 and 180 beats per minute. He could also induce and then treat ventricular fibrillation. He noted that different pacing sites seems to create different kind of beating (probably pacing left versus right ventricle).11

Up until this point all cardiac pacing had been epicardial. However, in 1927 Marmostein paced the right atrium and ventricle using a transvenous approach.12 Although this is the most common technique currently used, it was forgotten for years until rediscovered by S. Furman.13

Previous devices were basically leads hooked up to a power source where the current needed human control. To make the control automatic, in 1932 Albert Hyman built an external pacemaker generator and control box. His device generated electricity as determined by a clock. He hooked this generator up to an epicardial lead on the right ventricle first in animals, then in humans.14

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