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Local doctor spends decades keeping hearts beating

Brandon Paykamian • Mar 15, 2020 at 9:30 AM

In the front lobby of Dr. Paul Brown’s internal medicine office at State of Franklin Healthcare Associates, there sits a large glass display showcasing the evolution of pacemaker technology — a story in which Brown has played an integral role since the 1970s.

“We’ve learned about this little by little,” Brown said. “It’s been a 40-year process of learning. We’ve continued to learn more and more, and as we do, our pacemakers are getting better and better.”

Before the Indianapolis native helped form what was then known as Johnson City Internal Medicine in 1977 through working with Drs. Burgin Dossett and David Freemon, Brown was closely involved in early pacemaker development, which led to improvements that would prolong and save thousands of lives in East Tennessee and elsewhere.

Brown, an Emory and Henry College and Medical College of Virginia alumnus who once served as a U.S. Army major in the 30th Field Hospital in Germany, developed an early interest in how the heart works long before he came to Northeast Tennessee.

After Brown graduated from the Medical College of Virginia, he studied under Dr. T.J. Ryne, the chief of cardiology at Boston’s St. Elizabeth’s Medical Center, who was working at the forefront of medical research into the heart’s natural electrical currents.

“It was at the Medical College of Virginia while I was on my surgical rotation that we did the second heart transplant in the world, so I developed an interest in the heart. I ended up going up to Boston, and there I worked with T.J. Ryne. He was working on this idea of developing this thing called a ‘pacemaker,’ and it wasn’t even (fully) developed at that time,” he said, adding that the earliest implants were “as big as hockey pucks.” 

While today’s pacemakers are much smaller and work in sync with the heart’s rhythm needs, the very first pacemakers were essentially car batteries hooked into metronomes with leads to the patient that emitted an electrical shock to supplement the heart’s natural electrical circuitry. Early pacemakers were much larger and less responsive to the heart’s needs, according to Brown.

By the time Brown arrived in Johnson City, he said there were several early pacemakers in use. He said they were much less advanced, and they would simply “just shock the heart.”

Seeing the problems with early pacemaker technology, Brown used his expertise to oversee clinical trials and work with engineers from the ’70s through the ’90s to help develop these early devices into the small, reliable pacemakers used by many today.

“I had the opportunity to work with (companies like) Medtronic and also with Cortis to start developing pacemakers that we would be able to control from the outside," he said.

Brown worked closely with engineers like Meditronic’s Dr. Earl Bakken, who developed a wearable pacemaker powered by a battery to replace the old bulky devices that had to be wheeled around and plugged into walls.

After the space age, medical researchers had more access to new plastics, metals and transistors that allowed newer pacemakers to last longer and decrease in size. Newer alloys allowed them to be implanted without being rejected by the body. 

During the early stages of pacemaker development, Brown also worked with Dr. Page Powell to implant pacer wires into patients. Powell opened the chest wall, after which Brown planted the pacemaker’s wires outside the heart surface and programmed the generator. Brown recognized the need for a different form of delivery that didn’t involve two doctors for the procedure.

This prompted Brown and Cortis engineers to develop the first introducer, which allowed doctors to implant a lead to attach to the external wall pacer through a vessel to the heart. Doctors in the Tri-Cities became the first to implement this new technique, according to Brown.

Through work such as this, as well as advanced echocardiography monitoring methods Brown studied and developed in the ’80s, Brown and his colleagues continued improving the devices into what they are today.

Today, pacemakers are less invasive, more efficient, smaller and more responsive to each individual's needs. Brown said it’s been rewarding to see the benefits patients have enjoyed after the work he put into improving pacemakers and monitoring methods.

“I still follow a lot of pacemaker patients, and if they need a new one, my friends the cardiology guys here in town help to put in new generators,” he said.

To teach others about the evolution of pacemakers and the role in which he and his colleagues played, Brown said he’s planning on donating his extensive pacemaker collection to the Museum at Mountain Home, located at the James H. Quillen Veterans Affairs Medical Center.

Through his collection, visitors will get to see how pacemakers advanced from the crude devices they were decades ago. 

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