Clinical Experience with Nuclear-Powered Pacemakers (Promethium-147)

Abstract

Since its initial application by Elmquist and Senning in the year 1958, permanent electrical stimulation of the heart in bradyarrhythmias has become the most successful technical mode of therapy. Despite numerous improvements, both of a medical and a technical nature, however, various, still unresolved difficulties have developed with increasing observation time. One of the main problems is to be seen in the relatively short operating life of the pulse generator driven with conventional chemical batteries, which lies between 2 and 3 years. This means that the patient, even in the absence of complications, has to subject himself to a number of surgical procedures for the purpose of replacing the pacemaker. Apart from the negative subjective aspect, this represents a certain repeat surgical risk for the patient and, last but not least, also represents an economical problem for the health insurance carrier. For these reasons, interest has been concentrated during the last few years on the utilization of long-lived sources of energy. The application of “biological fuel cells” which function in accordance with the galvanic principle and which seemed very promising since, apart from the question of minification of the device, they also held out promise of a considerable reduction in costs, still remains in the experimental stage ⁽¹⁾. This is because it has been shown that the anode material corrodes relatively quickly and that, in addition, unexpected tissue reactions occur. In consequence, such pacemakers are, at the present time, unsuitable for clinical application and are still inferior to the conventional mercuric oxide batteries.