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clinical setting, and the primary challenge was to ensure pacing without any problems such as lead fractures or dislodgment, threshold changes and early battery depletion, thus technical improvement was promoted. Regarding the pacemaker body, efforts were made to reduce its size and prolong the battery life with technological developments. Alongside pacemaker therapy, many advances have been made in the understanding of arrhythmias. The older generation leads showed easy dislodgement or displacement, a high rate of fracture and inflammation at the tip of the electrode with increasing pacing thresholds, causing premature battery depletion and problems.4 The structure and materials of the electrode have been variously changed, from bare-metal electrodes to porous electrodes with a lower tendency to dislodge and showing improvement in pacing threshold. As electrode tip materials, titanium, iridium, and vitreous carbon have been in use. The conductor coils were designed to improve tensile strength and increase resistance to fractures, but chronic threshold increase was n 1932, Hyman invented an external cardiac stimulator to electrically stimulate the heart from outside the body using a needle electrode.1 He named this stimulator an “artificial pacemaker”, which is the name still generally used. In 1958, Åke Senning, a thoracic surgeon at the Karolinska Hospital in Stockholm, implanted myocardial electrodes and a pulse generator with a rechargeable nickel-cadmium battery in a 40-year-old patient using an open thoracotomy,2 and in 1958. Furman et al performed endocardial pacing using an external pacing device, and a prototype of the current VVI pacemaker was developed in 1963.3 After this, the transvenous approach became popular and implanting pacemakers has become a key technique for surgeons during challenging procedures.

The Lead Structure Does Not Always Work as Designed