Original Article
The Australian History of Cardiac Pacing: Memories from a Bygone Era

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Although Dr Albert Hyman in New York is believed to have built the first cardiac pacemaker in 1932, he acknowledges Dr Mark Lidwell in Sydney, Australia as having not only built a pacemaker, but also successfully used it to resuscitate a newborn infant in or before 1929. Fully implantable pacemakers, however, were not possible until 1958, following the development of the silicon transistor. Within three years of that first implant, a pulse generator attached to epicardial leads was implanted at the Royal Melbourne Hospital. About the same time, an engineer in Sydney with intermittent complete heart block who had received epicardial leads and an external pulse generator proposed a simple sensing circuit, leading to the design of the first demand pacing system. By the mid 1960s, physicians were inserting transvenous leads in the right ventricle attached to pulse generators implanted in the anterior abdominal wall. In 1963, an Australian pacemaker company, Telectronics, was founded in Sydney. This innovative company-designed many of the features of transvenous leads and pulse generators we take for granted today. Australia also played a leading role in the design or early evaluation of the lithium power source, lead fixation, steroid elution, automatic anti-tachycardia pacing algorithms and the minute ventilation rate adaptive sensor. This manuscript describes the challenges and frustrations of those pioneers: physicians, surgeons and biomedical engineers.

Section snippets

Earliest Australian Experience of Cardiac Pacing

In 1959, recognising the potential value of cardiac pacing for debilitating Stokes Adams attacks and asystole, Dr Graeme Sloman at the Royal Melbourne Hospital, Victoria, requested that the Department of Medical Electronics build him two battery operated external pulse generators; one providing low voltage output stimulation to an endocardial or epicardial pacing lead (Fig. 2) and the other provided high voltage outputs to large bare metal electrodes strapped to the chest wall. At the time, the

The First Demand VVI Pacemaker

In May 1961, at the dawn of the pacing era, a 66 year-old male presented to the Royal Prince Alfred Hospital in Sydney with intermittent atrio-ventricular block resulting in syncope [9]. As was the surgical preference at the time, the patient had epicardial pacing leads attached to an external pulse generator. Because the heart block was intermittent, the patient, an engineer, devised his own pulse generator on/off switch. The patient would sense his heart going into block and even whilst

Transvenous Endocardial Pacemaker Implantation

Early pacemaker recipients were required to earn their implants. Symptoms had to be dramatic and the prognosis poor without a pacemaker. The procedure was usually performed under local anaesthesia using a cephalic or external jugular vein cutdown. To aid positioning of the lead at the right ventricular apex, a wide bore Cournand diagnostic catheter flushed with heparinised saline (Fig. 5C) was loaded with the lead and passed to the right atrium and then directed towards the right ventricular

Telectronics: A Pioneering Australian Pacemaker Company

In the early 1960s, an Australian engineer, Edward Hulme, built a number of rate and voltage adjustable temporary pulse generators for Sydney hospitals to be used mainly for heart block following heart surgery [9]. The design was based on his “Flasher Lite” road maintenance lamps technology which can be still seen on Australian roads. At the same time, Keith Jeffcoat an electronic engineer working at the Children's Hospital in Sydney made improvements to the Hulme pacemakers and undertook a

The Pacemaker Lead

Parallel research and development occurred with pacemaker leads. In the early 1970s, it was recognised that the 4F polyurethane insulated leads, although resistant to fracture were too difficult to implant. The future lay in the stylet loaded, initially unifilar, helical lead. Such leads were more liable to fracture and soon became multifilar. Wedge tipped passive fixation devices became popular, although an Australian concept with a balloon was unsuccessful [14]. Eventually tines and steroid

The Lithium Anode Power Source Era

In the early 1970s, because of disappointment with the mercuric oxide/zinc cell, a number of companies were investigating other power sources for implantable cardiac pacemakers. These included a nuclear powered pacemaker, a small number of which were implanted by Dr Harry Windsor at St Vincent's hospital in Sydney. In 1967, the lithium-iodine cell was invented and today still remains the preferred energy source for cardiac pacemakers.

The potential of the lithium-iodine cell as a solid state

The Third Decade of Cardiac Pacing

With the development of reliable long-life pacemakers, interest turned to other aspects of electrical stimulation of the heart. With the emergence of electrophysiology, patient initiated implantable pacemakers for paroxysmal supraventricular tachycardias were investigated [22]. Telectronics subsequently developed PASAR™, the first fully automatic programmable pacemaker for paroxysmal tachycardias [23], which although successful, had a limited life because of the subsequent development of

Concluding Remarks

There are few symptoms in medicine more dramatic, debilitating, demoralising or depressing than Stokes Adam's attacks due to intermittent complete heart block resulting in asystole. Although the early days of cardiac pacing were frustrating, the workers took up the challenge to develop reliable, long-life implantable devices, which are today taken for granted. The Australian pioneers: physicians, surgeons and biomedical engineers played a critical role in this early development. Their story has

Conflict of Interest

There is no conflict of interest.

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    Copyright © 2011 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Ltd. All rights reserved.