Development of Pacing, Electrophysiology and Defibrillation in India

Cardiac Pacing History of cardiac pacing in India dates back to late 1960s. Kar1 reported that cardiac pacing was introduced in India in 1966. Basu2 while discussing on cardiac pacemaking in Calcutta, mentions that the first pacing was performed in April 1967 at the Institute of Post Graduate Medical Education and Research (IPGME&R). Bhatia et al3 started pacemaker implantation at AIIMS, New Delhi in 1968. Their first patient was a doctor from Assam and the pulse generator was supplied by Medtronic Inc. The pulse generator was powered by a mercuryiodide battery which lasted for about 2 1⁄2 years, after which the patient underwent pulse generator replacement. Unfortunately he succumbed to miliary tuberculosis about a year after that. Currently around 8000 pacemakers are being implanted annually in India, in various centers around the country. The IPGME&R is the centre which implants maximum number of pacemakers in the country1. Various hypotheses has been put forward to explain the high incidence of conduction system disorders in the Eastern part of the country. Mustard oil is the usual cooking medium in the Eastern part of the country. Erucic acid content of Mustard oil is around 48%. Studies conducted by the Indian Council of Medical Research4 has shown erucic acid content in all the 50 heart samples obtained from Calcutta (Eastern part of India) while none of the samples from Trivandrum or Madras (South India) showed any trace of erucic acid. The cooking medium in the latter regions is coconut oil, with no erucic acid content. Erucic acid has been shown to produce myocardial fibrosis and lipidosis5-7. High incidence of heart block has also been reported from Sweden8 , where the cooking medium is rape-seed oil which also has a high erucic acid content. More studies are needed to conclusively prove whether Mustard oil is the etiological factor in the high incidence of heart block in the Eastern regions of India. The first temporary pacemaker manufactured in India was the Khalilullah-Mendez pacemaker, which was marketed in 1970. It was a single chamber fixed rate pacemaker with facility for adjustment of pacing rate and pacing current. The device was jointly developed by Prof. M. Khalilullah at G.B. Pant Hospital, New Delhi and Mendez, an engineer-entrepreneur. Khalilullah-Mendez team also manufactured an indigenous monitor-defibrillator which was known as KM monitor-defibrillator. The first permanent pacemaker manufactured in India was from Shree Pacetronix Ltd. The pulse generator was called Ventralith-I and it was a non-programmable VVI pacemaker. First implant was on September 9th, 1994 at Kastruba Hospital, Bhopal. Subsequently Shree Pacetronix has started manufacturing multiprogrammable pacemakers as well. The first