MY MEMOIRS OF THE ROYAL VICTORIA HOSPITAL PACEMAKER IMPLANTATIONS IN THE WEST WING OVER HALF A CENTURY AGO!

Editor,

In 1964 I became a Senior House Officer in Dr. Pantridge’s Wards 5 & 6 at the Royal Victoria Hospital, Belfast. In the course of my many duties, I became interested in Pacemaker Implantation, which was becoming increasingly employed in the management of patients affected by atrio-ventricular block and other cardiac abnormalities.

During this time (and until 1987) I had access to the Radiology facilities in the R.V.H. ‘West Wing’, which was known as the ‘ACG Theatre’. This clinical theatre was situated near the far end of the ‘West Wing’ corridor, adjoining the main R.V.H. Corridor.

This sterile room housed equipment required for electrocardiographic monitoring of the patients, in addition to the radiology equipment, which was expertly operated by a full-time radiographer – Tom Littler, who hailed from the North of England and performed his work with military precision. There was also the large DC Defibrillator (Oh for one of today’s portable machines!)

Having access to this Facility enabled me, with the assistance of a trained R.V.H. nurse, to introduce and position the pacing electrodes with high precision. During the Sixties I implanted the first cardiac pacemaker in Northern Ireland (Ulster Medical Journal, Volume 59 No. 2, pp. 131-136, October 1990.) This procedure entailed proximal fluoroscopic venous canulation, employing a suitable accessible subclavian or supraclavicular vein, with shaping of the proximal portion of the electrode to facilitate conduction along the course of the vessel.

The patients who were scheduled for pacemaker implantation were admitted to the Cardiology Unit on the previous day. The male patients were prepped by having their chests shaved, and were prescribed mild sedation on the evening before. The procedure was explained to the patient and the consent form was signed. Nil by mouth was permitted from midnight. I did not require the assistance of an anaesthetist but instead I prescribed heavy sedation prior to the implantation. After the procedure the patient was wheeled on a trolley and returned to the Cardiology Unit.

During the mid-1960s I did not have the option of continuous monitoring equipment, but the patient’s vital observations were monitored and charted. ECG Recordings were made frequently during the first twenty-four hours. An ECG Technician pushing a mobile cart containing a large ECG Machine with print-out capability was employed during this period. After a few days in hospital - and provided the patient’s condition was stable, the patient would be discharged with a letter for his/her doctor and a follow-up appointment.

The patients fitted with these early Pacemakers had to have them replaced every two years because of limited battery longevity.

In the early 1970s, however, the pacemakers themselves were lighter in weight and smaller, and - very importantly - were fitted with rechargeable batteries. This new development was a great boon for the patients. Moreover, the rapid technological developments that permitted them to experience such a convenience certainly underlined the point that this was, indeed, a noteworthy era in Medicine.

The above Memoirs are my recollections of Pacemaker Implantation performed in the ACG Theatre, West Wing, Royal Victoria Hospital, Belfast over Half a Century ago.