Intrathoracic Gadgets In The New Millennium: Primer On Pacemakers And Cardioverter-defibrillators

The invention of a simple, battery powered cardiac pacemaker by Earl Bakken and C W Lillehei in 1958 has prevented millions of untimely deaths. Major advances in pacemaker technology, including development of demand modes and rate responsiveness, have permitted these patients to lead relatively normal lives as well. Additionally, the creation of the implantable cardioverter-defibrillator by Michael Mirowski in 1985 has decreased the rate of sudden death in patients prone to tachydysrhythmias. These technologic advancements, coupled with the electronically hostile environments of the operating and procedural rooms, have complicated the job of delivering anesthetics to these patients for a variety of procedures. Much of the information that has been published regarding the care of these patients has become outdated, and new indications for implantation of pacemakers, ICDs, or both have appeared. In this primer, we attempt to provide basic information about implantable pulse generators and the care of the patient with these intrathoracic gadgets.