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Pacemakers and magnets: An arranged marriage

      Multi-programmable heart rhythm devices are so prevalent today that its easy to forget the brief but amazing history of cardiac pacing, which started only about 50 years ago, in the late 1950s. Pacemakers became implantable in the 1960s; before that they were external devices powered by AC current or by batteries. Once these devices became implantable, communication with the device became an issue. Before the development of telemetry communication with pacemakers in the 1970s, magnets were routinely used to assess battery status or to change the pacing rate. In the mid 1980s, when the implantable cardioverter-defibrillator (ICD) became available, communication with these early devices was very limited. These devices came from the manufacturer with a preset rate cutoff for tachycardia detection, no pacing therapies, and only one shock strength. Magnets were used to turn the device on and off and to assess charge time to charge the capacitors, thereby to reform the capacitors periodically to facilitate quick charging in case of needed shocks. Additionally, determination of battery longevity and the decision to replace the ICD depended on a predetermined capacitor charge time specific to the device.
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