How does the device work and what contribution does Rostec State Corporation make to its creation
Photo: Press Service of the Administration of the Podolsk Urban District
Approximately 50,000 pacemaker implantations are performed annually in Russia The first surgey in our country took place 64 years ago. The implantation was performed by Alexander Bakulev, one of the founders of Russian cardiovascular surgery. The device implanted was a domestically developed device manufactured at the Klimovsky Stamping Plant.
The Rostec State Corporation's portfolio now includes the company Kardioelektronika, which has manufactured more than 31,000 pacemakers of various types over the last five years. These devices are saving patients' lives across Russia, from Kaliningrad to Kamchatka.
A Generator of Electrical Pulses Within UsThe heart has its own electrical system that ensures precise and synchronized contraction of all chambers. An electrical impulse of a specific frequency and shape, entering the heart muscle, causes it to contract. Special muscle cells called cardiomyocytes help conduct these impulses. The sinus (or sinoatrial) node is located in the upper part of the right atrium. It is this node that rhythmically generates electrical impulses. Sometimes, with age or due to illness, the sinoatrial node stops functioning properly, causing the heart rhythm to become irregular.
The atrioventricular node is located between the atria and ventricles. It receives the impulse and delays it for a split second, allowing the atria to contract and push blood into the ventricles before they contract. A cluster of cells called the Bundle branch block receives the electrical impulse from the atrioventricular node and then conducts it to the ventricles. A network of Cardiac conduction system fibers then distributes the impulse to the muscle cells of both ventricles. This causes the ventricles to contract synchronously from bottom to top, pushing blood into the aorta and pulmonary artery. The heart muscle then relaxes, the heart fills with blood, and the cycle begins again.
The spectrum of heart rhythm disorders is called arrhythmia, and the field of cardiology that studies and treats them is known as arrhythmology. These disorders can occur both at the stage of impulse formation and at the stage of its conduction. The rhythm may become too fast (tachycardia, over 100 beats per minute), too slow (bradycardia, less than 60 beats per minute), or irregular. One of the most common forms of arrhythmia is atrial fibrillation, which is characterized by irregular contractions of the atria. According to estimates by experts from the National Research University Higher School of Economics (HSE University), the number of patients with atrial fibrillation in Russia could exceed 3 million by 2036.
How a modern pacemaker works
Photo: Press service of Rostec State Corporation
A pacemaker is a small device whose primary purpose is to generate impulses to maintain the heart's rhythm. It is implanted in the body and connected to the heart via electrodes. A pacemaker consists of a main body and electrodes. The main body contains a pulse generator, a microprocessor, and a battery. The electrodes are thin wires that provide communication between the pacemaker and the heart muscle.
The microprocessor monitors the heart's natural electrical activity through the electrodes. If the information about a heartbeat is not received within a set period (programmed by the doctor), the microprocessor signals the pulse generator to produce a short electrical impulse. This impulse is delivered to the heart via the electrode, causing the heart muscle to contract.
The pacemaker implantation procedure is performed under local anesthesia. The electrodes are inserted into the heart through the subclavian vein, and the device's body is implanted into a subcutaneous pocket under the collarbone. This procedure is minimally invasive, meaning it causes minimal trauma to human biological tissues. However, this was not always the case. Achieving this level of precision and technological sophistication was made possible by the developments and experiments in cardiac pacing conducted by cardiac surgeons and engineers throughout the 20th century.
On the Path to the Perfect Device
The first devices designed to "stimulate" the heartbeat were quite bulky and unreliable. In 1929, the anesthesiologist Mark Lidwill presented a paper at a conference about a device he had created that stimulated the heart. It performed with mixed success. By the 1930s, American cardiologist Albert Hyman had developed an electromechanical pacemaker. The device weighed over 7 kg and, like Lidwill's device, had many shortcomings.
Breakthrough discoveries occurred in the mid-century. In 1950, John Hopps and Wilfred Bigelow developed the first portable external pacemaker powered by electricity. Seven years later, American engineer Earl Bakken created the first portable battery-powered pacemaker. And in 1958, Swedish engineer Rune Elmqvist invented a totally implantable pacemaker powered by rechargeable nickel-cadmium batteries. The surgeon Ake Senning implanted this device in 43-year-old Arne Larsson. The device malfunctioned several times, and Larsson underwent over 20 surgeries, but he lived long enough to die in 2001, not due to heart disease.
Photo: Press service of Rostec State Corporation
The first pacemaker in the USSR was developed by the distinguished surgeon and academician Alexander Bakulev. In 1960, Bakulev approached the country's leading designers with a proposal to develop a Soviet implantable pacemaker. The development was undertaken by Alexander Nudelman's Precision Engineering Design Bureau. The EKS-2 pacemaker implantation surgery, supervised by Bakulev, took place in December 1961. The EKS-2 had a mercury-zinc battery that lasted 2-3 years and two electrodes for asynchronous stimulation. The device was produced from 1962 to 1983 and helped save the lives of thousands of people.
Modern devices are much more advanced than their predecessors. Pacemakers can now adapt to the body's individual physiological needs, including physical activity, and accumulate data on heart function. Some models allow for MRI procedures, which previously was impossible. The first MRI-compatible pacemaker in Russia was manufactured by Kardioelektronika, a subsidiary of the Rostec State Corporation.
Kardioelektronika: A Contribution to the Nation's Health
Kardioelektronika is one of the leading Russian manufacturers of pacemakers and electrodes. In 2024, the company produced approximately 8,000 devices for patients with heart conditions. Modern technology and experienced specialists enable Kardioelektronika to ensure high precision and uninterrupted control of the technological process. The company is currently working on developing new types of products to expand its product portfolio.
This year, at the "Health of the Nation – the Foundation of Russia's Prosperity" forum, the company presented Apollo MRI, the first Russian pacemaker that allows patients to undergo MRI examinations without restrictions. It is designed for people with severe arrhythmia, such as bradyarrhythmia—a severely reduced heart rate. The device is implanted subcutaneously, and stimulation parameters can be adjusted to the patient's physiological characteristics. Built-in algorithms for assessing heart rate, respiration, and other parameters ensure the required stimulation rate. A "sleep" function reduces the frequency of electrical impulses at night. Apollo MRI allows for diagnostics, including recording electrocardiograms and collecting statistics. The device has a service life of nine years or more.
According to specialists at Kardioelektronika, "enhancing the safety of medical devices and integrating solutions that comply with international standards" is becoming a key direction for the domestic medical device industry. Apollo MRI was developed as part of the import substitution program. Its creation was putted on production with the direct involvement of Sergey Reutov, Deputy General Director for Production at Kardioelektronika. Reutov began his career as a technician-technologist in the pacemaker production workshop. He has dedicated 30 years to creating medical devices for cardiology.
Devices manufactured by the company are used by over one hundred leading scientific and medical centers across the country. These include the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, the A.V. Vishnevsky National Medical Research Center of Surgery, and the M.F. Vladimirsky Moscow Regional Research and Clinical Institute.
The fight against cardiovascular diseases is one of the key areas of the major national project "Long and Active Life." One of the project's goals by 2030 is to increase by 10% the number of patients with heart disease who have lived the previous year without acute cardiovascular events. The introduction of devices like the Apollo MRI will contribute to achieving the goals set by the national project and will help save thousands of lives.
News: Press service of Rostec State Corporation