Thirty-one years of clinical experience with "nuclear-powered" pacemakers

From 1973 through 1987, 164 radioisotope powered ("nuclear") pacemakers were implanted in 139 patients at the Newark Beth Israel Medical Center. Patient survival was much as might be expected from an age group as selected for this program. At 31 years (January 2005), 12 of the 139 patients (9%) were still alive. The experience reported here encompassed a span of 16 years of implantation with a follow-up of slightly more than 31 years. The problems encountered along the way were not remarkably different from those encountered in general clinical experience with pacemakers, except that the number of reoperations was fewer. In fact, most patients died with the initial implant in place. Deaths most commonly were due to cardiac causes (54%). The frequency of malignancies was similar to that of the age-matched population; primary tumor sites were randomly distributed. These results show that nuclear pacemakers were safe and reliable. Their longevity and the resulting decrease in reoperations offset their greater initial cost.