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«D. John Doyle (This essay is in the Vancouver style: uniform requirements for manuscripts submitted to biomedical journals) Doyle: Rise and Fall of ...»

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However, while the potential benefits of a longer-lasting pacemaker and the alternative of using a battery-operated pacemaker are perhaps easily explained to patients, it can sometimes be difficult to get a handle on the specific risks involved. This is because in some cases there may be theoretical risks that may not be readily quantified, such as the risk of developing a malignancy or other serious complication such as radiation fibrosis while being exposed a source of radioactivity over a prolonged period.

Even more difficult would estimating social risks, such as the risk that a patient with a nuclear pacemaker might be kidnapped and murdered with a view to committing a terrorist act by extracting the plutonium fuel and introducing it into (say) the Pentagon’s air intake system. (Inhaled plutonium dust is very carcinogenic: a mere one ten-thousandth of a gram (0.1 milligram) ingested in this manner can cause cancer [13].)

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The Future Although nuclear-powered pacemakers do not appear to have a future, continuing developments in pacemaker technology are inevitable. As an example of a European product that will likely become available in the US, Biotronik has developed an implantable pacemaker / defibrillator that can not only deliver life-saving defibrillation shocks when patients are in ventricular fibrillation, but also adds an ability to monitor the performance of both the heart and the device itself. This product is also able to send daily diagnostic information to clinicians using the mobile phone network as well as immediately in the case of a critical event.

Figure 8: Photograph of the Biotronik Lumax 300 HF-T pacemaker with the ability to send routine and emergency diagnostic information via the mobile phone network and by other means.

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References [1] http://www.eisenhower.archives.gov/atoms.htm [2] Metzger, H. Peter. The Atomic Establishment. NY: Simon & Schuster, 1972, p. 227 [3] http://www.rachel.org/bulletin/bulletin.cfm?Issue_ID=610 [4] http://www.radiationworks.com/flyingreactor.htm [5] http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01100.html [6] Bigelow WG, Callaghan JC, Hopps JA. General hypothermia for experimental intracardiac surgery. Ann. Surg. 1950; 1132: 531-539.

[7] http://www.medtronic.com/brady/patient/pacemaker_history.html [8] http://experts.about.com/e/a/ar/Artificial_pacemaker.htm [9] Parsonnet V, Berstein AD, Perry GY. The nuclear pacemaker: is renewed interest warranted? Am J Cardiol. 1990;66:837-42.

[10] http://www.nrc.gov/reading-rm/doc-collections/gen-comm/infonotices/1998/in98012.html [11] Chauvel C, Lavergne T, Cohen A, Ducimetiere P, Le Heuzey JY, Valty J, Guize L. Radioisotopic pacemaker: long-term clinical results. Pacing Clin Electrophysiol. 1995;18:286-92.

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[12] Parsonnet V, Driller J, Cook D, Rizvi SA. Thirty-one years of clinical experience with "nuclear-powered" pacemakers. Pacing Clin Electrophysiol.


[13] W. J. Bair, "Toxicology of Plutonium," in Advances in Radiation Biology, J. T.

Lett, H. Adler, and M. Zelle, Eds. Academic Press, New York, NY, 1974, pp. 255- 315.

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