LCHM Winter18 - 7
L C M E D S O C .O R G
to sit or stand without fainting. She also had
severe diabetes and had been in bed for such a
long time, she had developed a decubitus ulcer
in the sacral (buttocks) area.
Dr. Kasperian, a cardiologist from Philadelphia, came to The Allentown Hospital and
inserted a temporary transvenous catheter
into the right ventricle of Mrs. E's heart. This,
when connected to a battery powered external
generator, would transmit a small electrical
stimulus that would make the heart go faster,
the rate depending on the one you set.
NEARLY A QUARTER
BENEFIT FROM THE
two cavities which contain the lungs) to expose
the heart. A left thoracotomy to open the chest
wall was performed and the pericardium, the
membrane protecting the heart, was then
opened to expose the heart muscle. An area of
the left ventricle of the heart was selected and
the tips of the electrodes, about one half inch
long, were inserted into the heart muscle and
sutured to prevent their dislodgement.
We placed the pacemaker generator in the
subcutaneous tissue under the clavicle (collarbone) so that it would be accessible when needed
to service the pacemaker in the future. The
temporary wire electrode which had previously
been inserted was removed. The surgery was
successful, the pacemaker was installed, and
worked as expected. Mrs. E's recovery and
convalescence went well, even though her
hospital stay was prolonged until her decubitus
ulcer was adequately healed.
We had no battery powered unit in The
Allentown Hospital at that time. But, fortunately,
someone knew the family of a recently deceased
patient who had used an external battery powered pacemaker, and the family agreed to let us mistakenly been delivered to Allentown,
use the unit. This consisted of a wooden box NJ instead of Allentown, PA.
with special odd-sized batteries. Because of the
odd design of the batteries, we did have some
When I explained to Mrs. E and her family
difficulty obtaining backup batteries. Using this what had happened, they reached out to a
I must have followed Mrs. E for at least 10
temporary setup, Mrs. E's heart was now being family friend who had a small private airplane years after we installed her pacemaker, during
paced and she was comfortable. But a permanent and he agreed to fly to Allentown, NJ and which time several additional minor surgeries
completely implanted pacemaker was needed if retrieve the package. The pacemaker finally were performed to replace pacemaker generators
she were to enjoy any real quality of life.
arrived, but it wasn't sterilized because the and electrodes. Sadly, her husband eventually
electronic components couldn't withstand heat passed away and Mrs. E became senile. At a
The original implanted pacemakers consisted sterilization, the most common method of certain point her sons, both ministers, decided
of wires (electrodes) to transmit the electrical sterilizing surgical instruments and such. The that no more pacemaker changes would be made.
impulse and an implanted battery and timer only way the pacemaker could be sterilized Mrs. E finally passed away when the generator
(generator) encased in material that would without damaging it was with gas sterilization, failed; she was in her seventies, having lived a far
not cause any appreciable bodily reaction. The a common method of sterilization today, but at longer life than she likely would have without
generator was about three inches in diameter that time we had no gas sterilizers in Allentown. the pacemaker.
and one inch thick. Medtronic Corporation Fortunately, there was one available at St. Luke's
manufactured the pacemaker units, electrodes Hospital in neighboring Bethlehem, and they
Mrs. E was my first patient to receive a
and battery generators. These units were called agreed to sterilize our pacemaker.
pacemaker, but there were many more to follow.
fixed rate pacemakers because they sent out a
At the height of my practice, from which I've
fixed electrical impulse, usually set at 60 times
Next, I tested the generator by placing it on been retired since 1990, we followed about
a radio and turning the dial to the lowest AM 500 patients with pacemakers - so many that
band setting. Every time the generator sent we employed a full-time pacemaker follow-up
I explained the insertion of the pacemaker out a signal, we could hear a beep, confirming technologist named Mary Moyer.
to Mrs. E and her family and they agreed to that the unit was working. Then the entire
have the procedure. Then I called Medtronic unit had to be cleaned and wrapped in cloth.
Subsequent pacemaker implantations were
Corp. in Minneapolis, MN and ordered a Following gas sterilization, the unit had to be far simpler, and the electrodes were vastly more
fixed rate pacemaker. At that time, there aired for 12 hours, because the gas used in the complex. One of the major changes has been
were two ways it could be sent, either by process is irritating to body tissue and had to in the size of the units. The generator which I
Air Freight or Air Express. I knew when to be completely dissipated before implantation. implanted into Mrs. E was about an inch thick
expect the package, but it didn't arrive. The
and 3-4 inches wide, and now they're the size
company assured me the device had been
After all of that advance effort, we were finally of a silver dollar. It has been gratifying to watch
shipped, so I found out the name of the ready to proceed with the implantation. The early the advancement of pacemaker technology
carrier who had handled the package and pacemakers required a thoracotomy incision since I implanted that first one into Mrs. E
discovered that Mrs. E's pacemaker had into the pleural cavity (the space between the over 40 years ago.
WINTER 2018 | Lehigh County Health & Medicine 7