Chapter 21—Complex Electronics in Clinical Therapy: Clinical Use of Cardiac Pacemakers
SourcePacing of the heart has become quite complex, especially in comparison to its relative simplicity two decades ago when there was but one indication (complete heart block with Stokes-Adams seizures), one simple pacemaker (fixed rate), and only one way to implant it (through a left thoracotomy). Despite this growing complexity, pacemakers are implanted in 2500 “centers” in the United States, and approximately 100 000 units are implanted each year. In order to be a pacemaker “expert” one must be familiar with such disparate subjects as electrophysiology, clinical cardiology, surgery and its complications, and basic electronics. As will be seen, the extent of clinical need and the intricacy of device technology pose unusual problems for establishing standards for pacemaker function and clinical effectiveness.