Machines in Our Hearts: The Cardiac Pacemaker, the Implantable Defibrillator, and American Health Care

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Product Information:
ISBN-13: 9780801865794
ISBN-10: 0801865794
Publisher: JOHNS HOPKINS UNIV PRESS
Format: Hardcover
Pub Date: 05/2001
Edition Number: 1

Synopsis

"The cardiac pacemaker and the implantable cardioverter-defibrillator are among the most important medical innovations of the twentieth century. Machines in Our Hearts tells the fascinating story of this remarkable achievement. This is an original piece of work, building on a significant amount of new information from Jeffrey's interviews with key protagonists as well as careful analysis of primary and secondary source material."--Joel D. Howell, M.D., University of Michigan

Today hundreds of thousands of Americans carry pacemakers and implantable cardioverter-defibrillators (ICDs) within their bodies. These battery-powered machines--small computers, in fact--deliver electricity to the heart to correct dangerous disorders of the heartbeat. But few doctors, patients, or scholars know the history of these devices or how "heart-rhythm management" evolved into a multi-billion-dollar manufacturing and service industry.

Machines in Our Hearts tells the story of these two implantable medical devices. Kirk Jeffrey, a historian of science and technology, traces the development of knowledge about the human heartbeat and follows surgeons, cardiologists, and engineers as they invent and test a variety of electronic devices. Numerous small manufacturing firms jumped into pacemaker production but eventually fell by the wayside, leaving only three American companies in the business today. Jeffrey profiles pioneering heart surgeons, inventors from the realms of engineering and medical research, and business leaders who built heart-rhythm management into an industry with thousands of employees and annual revenues in the hundreds of millions. As Jeffrey shows, the pacemaker (first implanted in 1958) and the ICD (1980) embody a paradox of high-tech health care: these technologies are effective and reliable but add billions to the nation's medical bill because of the huge growth in the number of patients who depend on implanted devices to manage their heartbeats.

Table of Contents

1 Heart Block and the Heart Tickler 2 The War on Heart Disease and the Invention of Cardiac Pacing 3 Heart Surgeons Redefine Cardiac Pacing 4 The Multiple Invention of Implantable Pacemakers 5 Making the Pacemaker Safe and Reliable 6 The Industrialization of the Pacemaker 7 The Pacemaker Becomes a Flexible Machine 8 Slowing the Pace: The Industry's Time of Troubles 9 Competition through Innovation: Accelerating the Pace of Change 10 Preventing Sudden Cardiac Death: The Implantable Defibrillator

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Additional Description

CONTENTS
List of Illustrations and Tables x
Acknowledgments x
Introduction 1
CHAPTER 1 Heart Block and the Heart Tickler 14
CHAPTER 2 The War on Heart Disease and the Invention
of Cardiac Pacing 36
CHAPTER 3 Heart Surgeons Redefine Cardiac Pacing 5s
CHAPTER 4 The Multiple Invention of Implantable
Pacemakers 83
CHAPTER 5 Making the Pacemaker Safe and Reliable 107
CHAPTER 6 The Industrialization of the Pacemaker tae
CHAPTER7 The Pacemaker Becomes a Flexible Machine
161
CHAPTER 8 Slowing the Pace: The Industry's Time of
Troubles 186
CHAPTER 9 Competition through Innovation:
Accelerating the Pace of Change 209
CHAPTER10 Preventing Sudden Cardiac Death: The
Implantable Defibrillator 235
CHAPTER11 The 1990s and Beyond: "When Life Depends
on Medical Technology" 263
APPENDIX A Device Reliability, Qualification
Tests, and Improvements 291
APPENDIX B Number of Implantations 294
APPENDIX C ICHD Pacemaker Identification Code
296
Abbreviations 297
Notes 299
Bibliographical Note 353
Index 361
ILLUSTRATIONS AND TABLES
The First Published Electrocardiographic Tracing of the
Normal Heartbeat 16
ECG of Complete Heart Block 17
Structure of the Heart 20
Albert S. Hyman's Pacemaker, 1932 21
Paul Zoll Demonstrates His External Pacemaker, Mid1950s
38
C. Walton Lillehei with a Young Patient Recuperating from
Open-heart Surgery, 1961 62
Warren Mauston with his External Pulse Generator, 1959 63
Frank Henefelt and the First ChardackGreatbatch
Pacemaker, 1960 88
A Chardack-Greatbatch Implantable Pacemaker of the Early
1960s 112
P S. Walking the Hallway of Montefiore Hospital, Fall 1958
113
CPI's Microlith-P Pacemaker and Model 2000 Programmer,
1978 162
Dog Being Defibrillated, 1975 238
ECG of Ventricular Fibrillation 239
Guidant Mode1 2901 Programmer, 1997 267
TABLE 1 Technologies of Heart-rhythm Management 9
TABLE 2 The Search for a Long-term Pacing System,
1956-1960 84
TABLE 3 Implantations Reported, January 1961
August 1963 108
TABLE 4 Sales Income and Net Income at Medtronic,
1960-1972 139
TABLE 5 Some Indicators of Growth in American
Cardiovascular Medicine X55
TABLE 6 Selling and R&D Expenses at Medtronic,
Cordis, and Intermedics, 1980 195
TABLE 7 Estimated Market Shares of Pacemaker
Manufacturers, 1975 and 1980 2m
TABLE 8 Market Introduction of DDD Pacemakers 223
TABLE 9 The Pacemaker/ICD Manufacturers in
1998275