Engineering in Medicine

After more than a decade of successful application of cardiac pace­ makers in the therapy of cardiac rhythm disorders, technological and clinical experience has reached a level, at which a technical survey of this field should be of general interest and might promote the further improvement of pace­ maker therapy. The papers contained in this book were presented at the International Symposium on Advances in Pacemaker Technology, held at Erlangen on Sep­ tember 26 and 27,1974 under the auspices of the Societas Physica Medica Erlangensis. One of the traditional aims of the Societas has been the advance­ ment of diagnosis and therapy by the adaptation of medical skill to modern technology and scientific engineering conceptions. The major objective of this book is to present, in expanded form, the lectures given by internationally known basic and clinical researchers in the field of artificial pacing of the heart and to make that information available to a wider public. The experience discussed covers the principles and main methods of pacing using implantable and external, fixed rate, R-wave or P-wave triggered pacemakers with electrodes placed in the myocardium either surgically or transvenously, and powered by zinc-mercury oxide or rechargeable batteries. Particular emphasis was put on problems of pressing importance at the present time, such as the increase of pacemaker longevity with lithium­ iodide and nuclear-powered batteries or improved electrodes, as well as the postoperative management of a steadily increasing number of pacemaker patients.

Inhalt
1 Principles and Techniques of Cardiac Pacing.- Clinical Requirements for Pacemaker Therapy.- Electrophysiological Aspects of Cardiac Stimulation.- Techniques of Permanent Pacemaker Implantation.- Pacemaker Electronic Circuits.- 2 Clinical Experience with Various Pacing Techniques.- Results of Permanent Cardiac Stimulation Therapy.- Myocardial and Endocardial Pacing Systems - An Appraisal.- Transvenous Atrial Synchronized Pacing.- Pacemaker Therapy as a New Possibility for the Diagnosis and Treatment of Carotid Sinus Syncope.- Temporary Cardiac Pacing.- Problems with Temporary and Permanent Pacing for Cardiac Arrhythmias without AV-Block.- Clinical Complications Due to Pacemaker System Failures and Their Management.- 3 Patient Management.- Transtelephone Pacemaker Monitoring.- Long-Term Cardiological Follow-Up Results.- Computer Applications for Monitoring of Pacemaker Patients.- 4 Stimulation Electrodes.- Engineering Concepts of Pacemaker Electrodes.- The Significance of the Tissue Reaction around the Electrode on the Late Myocardial Threshold.- Studies of Short- and Long-Term Threshold Changes.- Electrochemical Aspects of Pacing Electrodes.- Endocardial Electrograms and Pacer Sensing.- 5 Longevity and Pacemaker Power Sources.- Long-Life Pacemakers.- Electrochemical and Radioactive Power Sources for Cardiac Pacemakers.- The Statistical Reliability of Lithium-Iodine Batteries.- A Long-Lived, Reliable, Rechargeable Cardiac Pacemaker.- Promethium and Plutonium as Fuels for Pacemaker Power Sources.- The Betavoltaic Pacemaker Power Source.- Design Criteria for Betavoltaic Nuclear Batteries.- Thermoelectric Conversion Systems for Nuclear-Powered Pacemakers.- Interpretation and Implementation of International Radiation Protection Standards for Cardiac Pacemakers in the USA.- 6 Clinical Experience with Long-Life Pacemakers.- Progress in Pulse Generator Longevity Preliminary Results of the CPI Lithium Iodide Unit.- Clinical Experience with Nuclear-Powered Pacemakers (Plutonium-238).- Clinical Experience with Nuclear-Powered Pacemakers (Promethium-147).- Initial U. S. Experience with Promethium-147 Fueled Cardiac Pacemakers.- Benefits and Risks of Promethium Battery-Powered Pacemakers.

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