How Does Our Garden Grow?

The pioneers who invented and developed cardiac pacing can look with pride on their incredible achievements. Very few technical advances can compare in terms of simplicity, effectiveness, and lack of complications. Indications for implantation have widened. In 1978, 96,723 pacemakers were implanted and 30,025 of these were replacements, despite a significant progressive increase in generator life span. Surgical fee^ and the cost of the devices have continued to rise in spite of the large number of units being implanted. A profusion of allied industries have developed (e.g. commercial pacemaker clinics, telephone transmission devices, pocket pacemaker testers and programmers). Although many strengths are apparent in the pacemaker establishment, some weaknesses remain. Surgical fees are out of proportion to the difficulty of the technique. This seems to be left over from the early days of pacing when a thoracotomy was required for most implantations. Also, for! a long time patients and third party carriers may have assumed that the cost of the implanted lunit was included in the surgeon's fee. The billings approach 3/4ths of the fee charged for repair of an abdominal aortic aneurysm, while the technical difficulty and risk is less than 1/1'Oth that of the vascular procedure. As percutaneous techniques and smaller pace-