Past and Future in PM Technology

I had my first PM implanted in 2009 and I was wondering how far the PM technology has come since 2003 and what can we expect in 10 years from now. I have been following with interest the development of the small pacemaker that Medtronic is developing but I haven't read much about it since this 2011 article

http://singularityhub.com/2011/03/03/medtronics-tiny-pacemaker-no-surgery-no-leads-wireless-communications/

Also what do you think the possibilities are that a viable "cure" will be found for regenerating pacemaker cells as stated in this recent article

http://www.sciencedaily.com/releases/2012/12/121216132509.htm

I am particularly interested in reparation of the AV node as I have complete heart block due to an ablation that didn't go according to plan or a better/smaller PM. Currently I have the Medtronic Adapta.

Interested in what everyone has to say.

Todd

10 Comments

Research Ethics

by ElectricFrank - 2013-01-27 02:01:19

I agree completely with HurtHeart.

There is another scary aspect to research and approval on new device, meds, and ....

Research use to be conducted in University settings where there was a reasonable amount of openness. Now it is done by commercial operations paid for by the company who's device is being tested. It is a closed system where the results are secret and manipulated by the originating company.

For myself, I would rather have my pacer replaced by one of the older models that have had the test of time. Let someone else find the bugs in a new model.

frank

A bright future !

by IAN MC - 2013-01-27 07:01:12

Hi Todd Don't be dragged down by these gloom-merchants. The future is looking fantastic ! Gene therapy and stem cell research will make pacemakers a thing of the past .

Already lab animals are re-growing their sinus nodes with the injection of a single gene. 30 years from now people will laugh about the bad old days when we had lumps of titanium with dangling leads implanted into our bodies.

There will only be one person in the world still using a Pacemaker .. his name is Frank and he will refuse to have the "new-fangled" technology !

Yours " glass half full' and full of optimism

Ian

There is No Such Thing as Honest Money!

by donr - 2013-01-27 09:01:34

Whether the Gummint, academia or commercial money is involved, there is ALWAYS an axe of some sort to grind. None of it is honest!

The commercial interest wants to come up w/ a product that is salable so the company can make money; academia wants a success for the honor & glory of the school & investigators; even the Gummint wants to have an outcome that substantiates some policy or desired result.

In the end, regardless of where the work is done, there is never enough testing to find all the hidden flaws in the end results & it is for the open market, w/ its tens of millions of patients & long time periods involved, that uncovers the hidden problems & hideous side effects.

That is only the start point. Enter the Gummint in its role of protecting the public from fraud & dishonest researchers & commercial enterprises - The US FDA (Food & Drug Administration), for example. The testing for efficacy & safety add more costs & time to get something useful & safe into the marketplace. Now throw in the special interest groups - not all bad - like patient advocacy groups demanding shorter lead times for promising drugs/devices to be available & you have fertile fields for disaster.

Compounding the problems of introducing new technology are real world problems encountered in expanding the envelope into unknown areas or environments. These are not restricted to drugs/medical devices. A few examples are as follows:

1) The British Comet airliner - discovered the problems encountered w/ metal fatigue around windows in pressurized aircraft operating at high altitudes.

2) Thalidomide an anti-emetic that caused birth defects in the babies of pregnant women who used it.

3) Pradaxa right now running afoul of the US litigation system because of unexpected (we hope) problems w/ spontaneous bleeding.

4) The Boeing 787 Dreamliner has a myriad of problems discovered now that it is in full commercial use that did not surface in testing.

5) Yaz/Yasmine birth control pills that started w/ such great hype & promise ("I didn't go to med school for nuthin...") that has fizzled on the altar of widespread use.

6) The shadow of doubt cast over the Global warming issues by the academic dishonesty of researchers who have apparently cooked the books to get the results they were hoping for.

I'd guess that some of the problems are the results of unintended consequences, but others are the results of pure greed & dishonesty.

There just plain is not anything known as a free lunch!

Don

Well said Don !

by IAN MC - 2013-01-27 10:01:13

The view that academia research , conducted in a university, is somehow purer and more productive than dirty corrupt commercial research , simply does not match the evidence. As you rightly say there are vested interests at work in both and there's always a danger that objectivity goes out the window.

If you take the pharmaceutical industry as an example; almost every drug breakthrough has come from commercial research. Countries where our competitive capitalist systems do not operate have not come up with a single drug innovation. University researches have certainly contributed but nowhere near to the extent of pharmaceutical company research labs.

For the reasons that you describe whenever we buy an innovative product we are guinea pigs and are taking part in a massive post-launch clinical trial but that would never put me off buying the latest I-Pad, car , TV , PM or gene therapy.

Cheers

Ian

On Being Subtle

by donr - 2013-01-29 09:01:44

Frank: Yes, I missed that nuance in your discussion. Upon re-reading your original post, I found it.

Ya shoulda been blunt, just like in your last comment - would NOT have missed your point then.

I agree w/you, completely, but you missed my unintentional agreement in my two examples of Thalidomide & Pradaxa - two drugs that went horribly wrong after release for general use.

We both could have used as an example genetic modification of food plants. The jury is still out on them as to their safety & efficacy at producing more yields of food w/o creating some sort of monster. If I understand correctly, all genetically modified food plants are banned in the Euro market. They are about as popular as small pox in the US - all from the concerns you have.

I just this AM read an article by John Ransome in the TownhallDaily web site about the cost of bringing a new drug to market & getting FDA approval for it - ASTRONOMICAL - & we still have the problems you & I mentioned. Which illustrates tellingly exactly what I said - the difficulty of finding ALL the problems during testing - you just cannot afford the magnitude of the sample sizes to unearth ALL the potential problems you find in general release.

An excellent example of the problems w/ "embedded" fixes is the advent & extensive use of integrated electronics in consumer products. Just cannot be fixed easily or cheaply. My wife, who is NOT trechnically inclined, tells of fixing the TV set back in the early 1950's by taking all the tubes out that she could get to (Of course that excludes the HV tubes inside the power supply can), & hauling them to the local TV repair shop. They tested them & for a couple bucks she got a new one & was off to the races watching the boob. You could also replace the random capacitor or resistor the exploded & made itself obvious by the shredded & blackened component visually lying in ruin. Not so w/ current electronic devices - it's now close to uneconomical to repair many devices.

We had a 32" TV set go bad. The closest that I could determine failure was to a Ckt Bd. to exchange it for a "Repaired" board cost nearly $200. And even then, there was no assurance that the board was correctly identified. The situation is even worse for the flat panel set that replaced it.

Then there is the computer-based storage of knowledge. If you are even remotely a Trekkie, you will appreciate my loving of BOOKS, as opposed to computers for that purpose. Just like Capt Kirk's lawyer in the episode when he faced a Court Martial for a death aboard the Enterprise.

Books are MUCH easier to browse. Try using the dysfunctional "Search" function at the top right of the home page. AAAAAAAARRRRRRRRRG!

Don

You missed something

by ElectricFrank - 2013-01-29 12:01:02

If my pacemaker turns out to have a serious problem it is easy to slice me open and replace it. If you inject genetic material in my body that turns out to have the long term effect of runaway growth (read cancer) it's pretty hard to take it out. Before I'm accused of saying that genetic engineering will cause cancer, I just used that as a hypothetical. My main concern with it is the very long term effects that may take place over a generation or two. There is also the variable of the genetics of the host patient.

Of course the developers don't need to be concerned. They will be long gone before the liability would appear.

I'm not worried about it. By the time it becomes a reality my ashes will be blowing in the wind.

frank

TV repair

by ElectricFrank - 2013-01-30 02:01:09

I worked as a factory warranty tech for Hoffman Television in 1950-1952 (damned army drafted me). I carried a tube kit that held every tube that they had ever used. The problem with just hauling the tubes to the local tube tester is that they would sell you several unnecessary tubes that were a little out of spec on the tester. When you replaced several tubes like that it often required a realignment particularly in the I.F. amps. I've worked on sets where the picture was so fuzzy it was hard to make out anything on the screen.

The funniest one though was a little old lady's set that I replaced a rectifier tube and fuse. I noticed that the picture tube and glass was covered with greasy dust so I took the time to pull the chassis and cleaned it. It looked great. Then I got back to the shop to be told of her calling to complain that her set was so sharp it was hurting her eyes. I went back the next day and had her watch while I adjusted the focus control. She told me exactly where to set it and was happy.

Kind of sound like someone getting a pacer and not liking their heart beating at a normal rate.

frank

TV & Nike Fire Control Set repair

by donr - 2013-01-30 10:01:41

Frank: Thought you'd like the TV tube story! Wife was probably 14 or so at the time. Don't recall the mfg of their set, but probably was not a Hoffman. Remember the Dumonts? Crosley? There were more makes of TV set than Carter had little liver pills. Guess all the strange references have driven away the youngsters in the crowd.

Your comment about re-aligning the IF strips reminded me of the ultimate in tube related problems. the Nike Fire Control set had over 600 tubes in it - and not a great variety of them, at all. How on earth you carried a full set of Hoffmans' tubes is beyond me - you must have traveled in a semi. Anyway, our spare tube supply was humongous - for the common ones, it numbered about 50. Of course, we had rack after rack of identical operational amps for the analog computers the system used. Our guys had figured out how (Of course) to replace a tube while we were operational w/o shutting off the heater voltages & the resultant mandatory warm up time when you turned the set back on. Needless to say, none of the chassis were screwed into the frames - no one wanted to have to screw around w/ having to waste time getting them out. Whenever we went hot, one very necessary member of the crew was a maintenance tech - in addition to the operators. It was crowded in those trailers & became a near panic of elbows knees when a tube went south on us. Naturally, the tech had to get around chairs & people & an observer or two - organized Keystone Kops, at best. All the safety switches that shut things down when cabinets were open & chassis pulled out were disabled - you wanted to be able to see which tubes were glowing. Ah, the nightmares of safety folks.

The worst thing that could ever happen was to be down for an overhaul by depot teams who came to our sites. Part of the experience was a complete set of brand new tubes. All the old reliable tubes were junked. Operations sucked for weeks afterward as we winnowed out the crap tubes that failed nearly immediately or were just not up to spec good enough for us. I learned a lot of new cuss words from the troops during that period.

Didja know who made the absolute best electron tubes in the world in the mid to late 60's & beyond? The Russians! We were converting to solid state devices by then but they still did not have the capability to produce them. A lot of their tubes were essentially clones of US designs, but enhanced & believe it or not, built to better quality standards. There was some really good stuff in their inventory - especially in the common tubes.

Ah, those were the days, my friend...

Don

Analog Amps

by ElectricFrank - 2013-01-30 11:01:08

By any chance were they the Filbrick K2-W? Look at
http://www.philbrickarchive.org/

I still have one around the shop somewhere. I had 60 of them in a rack at White Sands. My approach was to have an extra bank of 10 not in use but turned on. That way if a tube went at a critical time I had a warm one to swap. What I remember was the +/- 300V power supply they used. If an amp failed and went hard over just touching the output could defib you. Great block house heaters.

frank

Good Old WE

by donr - 2013-02-01 01:02:01

Frank - nothing so advanced as the Philbrick,

These were all 1943/44 Western Electric/Bell Labs designs. Originally designed for the WW-II M-33 Fire Control Center for AA Guns. MOF, the Nike versions were completely interchangable w/ the M-33 versions. AT WSMR we had old M-33 radars for tracking some targets on the range - principally Firebee drones, IIRC. We just did not have enough FPS-16's to do all the tracking necessary. You may have seen the trailers at some of the radar complexes - the antenna was on the roof of the van.

I was wrong about the number of tubes we had in the set - it was 1200. I tried to find out via Google what they were in the operational amps - nothing. BUT - recall that I said that the Russians made some pretty good tubes. I found an ad for Svetlana matched pair 6L6's for close to $100!

Is there even a vacuum tube even produced in the US any longer? Other than Varian's specialty high power tubes.

Don

You know you're wired when...

Your pacemaker interferes with your electronic scale.

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Sometimes a device must be tuned a few times before it is right. My cardiologist said it is like fine tuning a car.