Research Assessment #4

Name: Milind Renjit

Date: 10/8/18

Subject: Major Advancements in Pacemaker Technology

Teacher: Mrs. Brittain

MLA citation:  

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Madhavan, Malini, et al. “Advances and Future Directions in Cardiac Pacemakers: Part 2 of a 2-Part Series.” Journal of the American College of Cardiology (JACC), vol. 69, no. 2, Jan. 2017, pp. 211–235. EBSCOhost, doi:10.1016/j.jacc.2016.10.064.

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Assessment:

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For the fourth research assessment, the future of pacemakers and how its technology has evolved over time is what peaked my interest this week. The article being examined is titled, “Advances and Future Directions in Cardiac Pacemakers: Part 2 of a 2-Part Series.”, and it is an academic journal created by Malini Madhavan, MBBS, Siva K. Mulpuru, MD, Christopher J. McLeod, MBChB, Ph.D., Yong-Mei Cha, MD, Paul A. Friedman, MD. The article briefly discussed the current stage of development in pacemakers but had a more extensive focus on the overall end goal for the device in the future. In the eyes of most doctors, the device has mostly been at a standstill for the last 15-20 years up until roughly 2013. However, this new advancement is extremely expensive and this warrants many to choose an older device with more dated functions. This has given many doctors and researchers the motivation to make a product that will be available to the mass market.

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The article starts off by examining the history of pacemakers, and it began in the early 1950s when the first ever the pacemaker was invented. This form of the device was powered using an AC extension cord, coupled with a big pulse generator. Obviously, this was a very rudimentary implementation of the technology, is that it had to be connected to the outlet at all times, but it was the only device like it of its time. This is something that would never even be considered as an option by today's standards. Just a few years later the next iteration was developed which employed the use of a portable battery system, as opposed to being quite literally plugged into a wall outlet. There was only one major issue with this battery operated system. Due to the still-developing battery technology batteries had the tendency to severely overheated and at times burn patients. This a huge aspect of my possible final product if I choose to do a project on pacemakers. Because the future of pacemakers has everything to do with batteries.

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The next major development was made in 1958 when the first ever implantable pacemaker was introduced. This completely revolutionized the device because even until this day that same core concept of an implantable pacemaker is being used. From this point in history onwards, there was a minimal amount of advancement being made. This can all be traced back to the period during which the cardiothoracic field was in a boom. As referred to in my second research assessment, this era is what initially made cardiothoracic surgery the most lucrative field in medicine. With an influx of patients and various different cases to learn and adapt from cardiothoracic surgery advanced and so did its technology. The implanted pacemaker had a new rendition every few years with improved battery life and a smaller form factor. However, the issue of an eventual replacement was always a  nightmare for patients and doctors. As also discussed in that research assessment, we now know that the cardiothoracic field has fallen on tough times in recent years. These tough times has led to a standstill in the technological advancements up until very recently, and this is where the final product could begin.

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The most recent iteration of the pacemaker is the leadless pacemaker. This device is implanted directly into the heart instead of outside the heart with leads connecting to the heart. Amazingly the lead-based design has been used for roughly 40 plus years, and it has hit the very maximum potential that design can produce. However, this new design shows a new era for pacemakers and will most probably begin the final product I plan on creating. It is also a testament to the technological advancements of batteries and pulse generators, and this is most definitely due to the size and effectiveness of the battery and main components. This all comes back to allow for the smallest and most effective pacemaker of all time. However, this is not my main focus when it comes to the final product. The current generation of the pacemaker is very interesting, but it still shares one major issue with all of the previous generations of pacemakers. A battery, which means even this new pacemaker had to be replaced every few years. My goal this year is to discover and understand the concept of a batteryless pacemaker. This device can have the ability to be almost lifelong and will never need to be replaced. Only running off the motion of the heart it will not require a battery either. This is something that fascinates me endlessly. The idea that patients will never need a replacement and lead relatively carefree lives completely changes the meaning of what it means to have a pacemaker. No hassle, relatively no pain, and most importantly it has to be accessible to everyone.