The History of Pacemakers and Where They Are Heading

June 2, 2026

Cardiology Class Act 6 min read

 By: David Willett

Peer reviewed

The story of the pacemaker begins in 1918 in New York City, where Dr. Albert Hyman spent years following his residency studying the heart’s conduction system and exploring the possibility of resuscitating patients from asystole.1 As a 4th-year medical student, Hyman had observed a man revived from asystole for a brief amount of time using epinephrine.2 He considered the idea that the needle delivering the epinephrine was restoring heart rhythm rather than the drug. In 1932, his idea culminated in the patented invention of the “artificial pacemaker,” which replaced needle-prick stimulation with electrostimulation.2 While Hyman’s device is widely recognized as the first patented pacemaker, in 1926 Dr. Mark Lidwell independently developed a device to deliver an electrical shock that was used to save children born in cardiac arrest, but he is not credited with the first pacemaker device, as it was not patented or widely used.1

The next major step and possibly the most important innovation in the development of the modern pacemaker took place in 1958 in Sweden, where Drs. Ake Senning and Rune Elmqvist used newly invented silicon miniature transistors in a small pulse generator to create the first implantable pacemaker.3 Their first patient, Arne Larsson, was treated for complete heart block and required 26 different pacemakers due to the short battery life of the devices, but he outlived both Senning and Elmqvist, living to 86.1,3

Meanwhile, in Minneapolis, a young pacemaking company emerged from fear of a power outage. External pacing procedures were being performed during the 1950s for children following congenital heart disease repairs, including tetralogy of Fallot and ventricular septal defects.4 On October 31, 1957, a major power outage occurred in University Hospital in Minneapolis, which prompted Dr. Clarence Lillehei (“The Father of Open-Heart Surgery”) to ask a young electronic technician in the hospital named Earl Bakken to make a portable, battery-operated pacemaker for children with postoperative heart block.4 Bakken made the device. At this time, he was the founder of a little-known company called Medtronic, which previously did hospital electronic repairs but underwent a transformation following Bakken’s invention.5

Bakken and Medtronic did not see much financial success following this innovation until they incorporated the work of Dr. Wilson Greatbatch. In 1960, Greatbatch improved on Senning and Elmqvist’s work, adapting the battery to use a titanium case and zinc-mercury battery, allowing for longer battery life. Bakken started to produce this new style of pacemaker, which led to Medtronic’s eventual domination of the market.4,5,6 Meanwhile, Dr. Seymour Furman, a pioneer of cardiac electrophysiology, popularized transvenous pacing leads over endocardial or epicardial pacing leads, which carried a high risk of complications, replacing the need for thoracotomy for heart access. Transvenous pacing leads became standard in the 1960s and 1970s.7

1970s

In the 1970s, noninvasive programming was developed, in which radiofrequency telemetry links could allow for changes in pacing parameters.1,8 This innovation by manufacturers empowered physicians to adjust pacing rate and energy output via radio signals, tailored to the individual. Additionally, Greatbatch popularized the use of a lithium-iodine battery, greatly increasing longevity.6 In 1973, former Medtronic employees would form a new company called CPI and release the first lithium battery pacemaker as their initial product. 8 The Seventies also brought about dual-chamber pacemakers, a concept that is still widely used today, where both the atria and ventricles are sensed and paced. Dual-chamber sensing and pacing can provide a vital atrial kick and more effective ventricular filling, reducing dyssynchrony between chambers; however, this new pacemaker concept did not become popular until the 1980s.6,7

1980s

Beyond the dual-chamber pacemaker, in the 1980s a sensor was added to the pacemaker to monitor body movement and adapt the pacemaker rate to activity level.1,9 However, these sensors were not effective in correlating sensed motion with metabolic demand.9 For example, high movement actions like walking or using a rocking chair with low metabolic demand would create inappropriately high heart rates.

Lastly, the implantable cardioverter-defibrillator (ICD) was first utilized in this decade for high-risk patients post-MI or with sustained ventricular tachycardia.10 In 1980, despite hesitancy from the FDA, Dr. Michel Mirowski showed that ICDs could terminate ventricular fibrillation in high-risk patients, who qualified for the study if they had survived two prior cardiac arrests.10This invention was groundbreaking, as it provided the first internal and automated therapy capable of detecting and terminating life-threatening ventricular arrhythmias without external intervention.1,10 ICDs saw a great acceleration in use after 1985, when transvenous ICDs were created.10

1990s

Widespread adoption of dual-chamber pacemakers with improved synchrony and improved rate-adaptive pacemaking characterized the pacemaker innovations of the 1990s. This decade brought the “computerization” of pacemakers with microprocessors installed to dramatically advance the ability to detect and store information within the devices.1 This greatly improved the pacemaker sensors, as the combination of accelerometer-based sensors with advanced signal processing algorithms reduced inappropriate rate responses to environmental vibrations.8,9

2000s

At the turn of the century, biventricular pacing was created to synchronize the right and left ventricles by adding a lead through the coronary sinus to the epicardial surface of the LV on top of the standard RV, which improved contraction, symptoms, and survival.1 Indications for biventricular pacing or cardiac resynchronization therapy (CRT) are symptomatic heart failure and a prolonged QRS interval (³150 milliseconds), as this type of pacing can narrow the QRS interval and improve ejection fraction.11,12 In this way, pacemakers are no longer just focusing on reducing mortality but morbidity. Furthermore, new algorithms are being developed that better distinguish supraventricular arrhythmias from ventricular arrhythmias via dual-chamber detection, morphology discrimination, and pre-implant ECGs.12,13

The Future of Pacemaking

The current state of pacemakers is far from Dr. Hyman’s “artificial pacemaker” that delivered a shock through a needle in the chest, with a large focus on bypassing complications associated with transvenous leads and subcutaneous device pockets. The latest advancement is the creation of leadless pacemakers.

The conceptualization of the leadless pacemaker took place far before its use. In 1970, Dr. J. William Spickler invented the leadless pacemaker in hopes of reducing the complications of transvenous pacemakers, such as pocket infection, hematoma, pneumothorax, lead fracture, and lead dislocation.14 The first leadless pacemakers were placed in the right ventricle but lacked the ability to sense the atrium and to provide synchrony between the atrium and ventricle.15 Due to the rapid progression of transcutaneous pacemakers prior to the turn of the century, innovations in developing leadless pacemakers were put on hold.

Medtronic and Abbott changed this with their recent innovations in leadless pacemaking technology, expanding the device to a dual chamber version. Abbott’s dual-chamber leadless pacemakers also showed safety and effectiveness in the pivotal AVEIR DR i2i trial in 2023.15,16 The dual-chamber leadless pacemaker consists of 2 devices, both of which are attached to the endocardium, one being in the right atrium and the latter in the right ventricle, communicating to coordinate efficient beats.

?The future of pacemakers appears to be centered on perfecting the leadless pacemaker for CRT use and combining its action with a subcutaneous ICD. Due to the aging of the population, additional indications, and continuous technological improvements, the use of pacemakers continues to rise.16 Since the creation of Hyman’s first device, pacemaker technology has been a perfect example of the interface between electrical engineering and medicine and showcases how the need to maintain health drives some of humanity’s greatest inventions.

As I am an engineering graduate with experience at Medtronic, this invention has played a significant role in my decision to pursue a career in medicine and continues to motivate me to consider how engineering can solve problems in healthcare.

David Willett is a Class of 2028 medical student at NYU Grossman School of Medicine

Peer Reviewed by Michael Tanner, Executive Editor, Clinical Correlations

Image courtesy of Wikimedia Commons Kuroczynski, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>

References

  1.  Ward C, Henderson S, Metcalfe NH. A short history on pacemakers. Int J Cardiol. 2013;169(4):244-8. doi:10.1016/j.ijcard.2013.08.093. Epub 2013 Sep 9. PMID: 24083883.
  2.  Furman S, Jeffrey K, Szarka G. The mysterious fate of Hyman’s pacemaker. Pacing Clin Electrophysiol. 2001;24(7):1126-1137. doi:10.1046/j.1460-9592.2001.01126.x.
  3. Beck H, Boden W, Patibandla S. 50th anniversary of the first successful permanent pacemaker implantation in the United States: historical review and future directions. Am J Cardiol. 2010;106(6):810-818. doi:10.1016/j.amjcard.2010.05.015.
  4. Gott VL. Critical role of physiologist John A. Johnson in the origins of Minnesota’s billion dollar pacemaker industry. Ann Thorac Surg. 2007;83(1):349-353. doi:10.1016/j.athoracsur.2006.10.070.
  5. Earl E. Bakken, 94, dies; pacemaker pioneer and Medtronic founder. The New York Times. https://www.nytimes.com/2018/10/25/obituaries/earl-e-bakken-dead.html. Published October 25, 2018. Accessed October 24, 2025.
  6. Aquilina O. A brief history of cardiac pacing. Images Paediatr Cardiol. 2006;8(2):17-81.
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  8. Jeffrey K. Cardiac pacing, 1960–1985. Circulation. 1998;97(19):1978-1991. doi:10.1161/01.CIR.97.19.1978.
  9. Kusumoto FM, Goldschlager N. Cardiac pacing. N Engl J Med. 1996;334(2):89-97. doi:10.1056/NEJM199601113340206.
  10. Maron BJ, Estes NAM, Link MS, et al. Development of the implantable cardioverter-defibrillator. J Am Coll Cardiol. 2023;81(15):1432-1445. doi:10.1016/j.jacc.2023.02.019.
  11. Jaffe LM, Morin DP. Cardiac resynchronization therapy: history, present status, and future directions. Ochsner J.2014;14(4):596-607. PMID: 25598737.
  12. Kaza N, Htun V, Miyazawa A, et al. Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis. Europace. 2023;25(3):1077-1086. doi:10.1093/europace/euac188. PMID: 36352513; PMCID: PMC10062368.
  13. Al-Khatib SM, Piccini JP, Russo AM, et al. Cardiac implantable electronic devices. N Engl J Med. 2024;390(7):653-664. doi:10.1056/NEJMra2308353.
  14. Saleem-Talib S, Hoevenaars CPR, Molitor N, et al. Leadless pacing: a comprehensive review. Eur Heart J.2025;46(21):1979-1990. doi:10.1093/eurheartj/ehaf119.
  15. Knops RE, Reddy VY, Ip JE, et al; Aveir DR i2i Study Investigators. A dual-chamber leadless pacemaker. N Engl J Med. 2023;388(25):2360-2370. doi:10.1056/NEJMoa2300080.
  16. Khan MZ, Nassar S, Nguyen A, et al. Contemporary trends of leadless pacemaker implantation in the United States. J Cardiovasc Electrophysiol. 2024;35(7):1351-1359. doi:10.1111/jce.16295. Epub 2024 May 2. PMID: 38695242.

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