Cheney is carrying a Medtronic defibrillator. Pacemakers speed up the heart. Defibrillators slow it down, Papillon said.

“We see all age groups for defibrillators,” said Mike Gray, assistant director of Advanced Medical Imaging, Silverdale. “Typically, we see people whose ages are between 60 and 70 for pacemakers. Over 100 pacemakers a year are implanted at Harrison Hospital.”

Gray supervises the cardiac catheter lab, where pacemakers are implanted.

What exactly does a pacemaker do?

A pacemaker detects when the heart is beating too slowly, is irregular or is interrupted. A pacemaker is the power source of a pacing system, which contains electronics that deliver tiny amounts of energy to the heart. Today’s pacemakers incorporate aerospace and computer technology, containing up to 500,000 transistors — measuring as small as a half-dollar.

According to Dr. David Tinker, Bremerton, the major companies that provide pacemakers at Harrison Hospital are St. Jude Medical of St. Paul, Minn., Guidant of Indianapolis, Ind., and Metronic, Inc. of Minneapolis, Minn. Tinker, Dr. Arthur Lee and Dr. Michael Hegewald implant the pacemakers. Tinker has been implanting pacemakers for 20 years.

In the 1950s, the first pacemaker limited patients with an extension cord. Power failure was a constant concern. The end of a small wire, called a lead, was implanted into the heart. The other end of the lead was connected to an AC-powered, external pacemaker.

On Oct. 8, 1958, Arn Larsson, 43, received the first implanted pacemaker. It paced the heart continuously at a fixed rate. At the time of his death in Dec. 2001, he had received 26 pacemakers over 43 years.

The demand pacemaker was introduced in the 1960s. It sensed when the heart was beating on its own and provided pacing only when necessary.

Pacing occurs when the heart’s rhythm is interrupted, irregular or too slow. Tiny electrical signals are sent to the heart by a pacing lead. The lead is an extremely flexible wire that withstands twisting and bending, caused by body and heart movement. Leads contain a special medication on the tip, minimizing scar tissue. When one end of a lead is implanted into a heart muscle, the point-of-contact produces an inflammatory response. The medication reduces inflammation, which, in turn, reduces the amount of electricity needed from the battery, increasing its longevity.

The other end of a lead is connected to a battery, which is implanted in the chest or abdomen. The small, sealed, lithium battery typically lasts many years. When the battery is depleted, the entire pacemaker is replaced. The life of the battery is dependent upon lead positioning in the heart muscle.

Victoria Stebor’s job, as sales representative for St. Jude Medical, is to deliver pacemakers to hospitals and give lead positioning advice during surgery.

“I use an analyzer to assure the lead is properly positioned in the heart muscle,” she said. “If the lead is properly positioned, less energy is required from the battery.”

“Until the time a patient leaves surgery, I can make pacing adjustments with a programmer,” Stebor said.

A head from a programmer is placed over the implanted pacemaker. The programmer, which is kept at the hospital, monitors and adjusts pacing by sending new instructions to the pacemaker.

“We educate physicians and nurses to programmer technology,” Stebor said. “A complete checkup of a pacemaker is done once a year in the doctor’s office. In addition, every two to four months, a patient transmits the heartbeat over the telephone to the doctor’s office with a transtelephonic monitor. The process includes the patient placing a magnet over the pacemaker to measure battery status. If pacing speeds up or slows down, the pacemaker may need replacement.”

“The CareLink Monitor offers our customers a virtual office visit,” Papillon said. “It was approved by the FDA on May 8, 2002.”

The monitor is a small device that allows patients to collect information by holding a small antenna-type device over an implanted cardiac device. The monitor automatically downloads data and sends it through a standard telephone connection to the secure Medtronic CareLink Network. Patients view information on a personalized website. Clinicians access patient data by logging onto a clinician website with an Internet-connected computer or laptop.

The Defibrillator

A defibrillator is prescribed to people of all ages whose hearts beat dangerously fast. When a defibrillator detects a fast heart rate, it delivers electrical energy to restore normal rhythm. Electrical energy begins mildly and becomes progressively stronger as needed. The highest energy is called defibrillation. It provides treatment similar to defibrillation paddles used by medical personnel.

“If a person’s heartbeat is too fast, death can occur in five to seven minutes,” Papillon said.

Defibrillators are composed of small metal cases that contain electronics and a battery. As a pacemaker, a defibrillator is connected to the heart with a lead, and pacing is monitored and adjusted by a programmer.

In 1947, the first successful defibrillation was reported when an electric shock, using AC current, was applied directly to a patient’s heart during open-chest surgery. Development of the first implantable defibrillator began in the late 1960s. The first successful implant took place in 1980. However, five years passed before the FDA approved the implantable defibrillator.

“Defibrillators are implanted at institutions that have cardiologists who specialize in the conduction problems of the heart,” Gray said. “We send people to the University of Washington, Virginia Mason Medical Clinic and Tacoma General to have defibrillators implanted.”.