Although lives depend on them, they do their job entirely unnoticed: Today’s cardiac pacemakers are generally only slightly larger than a two-euro coin, weigh just a few grams, and are implanted in the patient’s chest wall. Until relatively recently, however, matters were very different.
The first cardiac pacemaker, invented in 1952, was the size of a small cathode ray tube (CRT) television, and the patient had to push it around like a shopping cart. With the invention of smaller batteries and reliable transistors, pacemakers quickly shrank in size in the years that followed, and as early as 1957 they could be worn around the neck like a pendant. In the same year, Swedish inventor Rune Elmqvist started working on the world’s first fully implantable cardiac pacemaker.
Arne Larsson was not well. Formerly a player on the Swedish national ice hockey team, by the fall of 1958 he could hardly get out of bed, and suffered from frequent bouts of unconsciousness. His heart would stop beating as many as 30 times a day, requiring his wife, Else-Marie, to resuscitate him each time with a blow to the chest. Larsson was just 43 years old – and his chances of getting much older were slim. But Else-Marie refused to give up. She had read in the newspaper that a doctor named Ake Senning was working with the engineer Rune Elmqvist at Karolinska Hospital in Stockholm to develop a cardiac pacemaker that could be fully implanted into the body.
She began contacting the two researchers every day, trying to convince them to help her husband. Senning and Elmqvist were skeptical – their research so far had focused on the ideal strength for the electrical current and the number of impulses per minute that should be used to stimulate the heart. Nevertheless, her persistence eventually paid off: Arne Larsson underwent secret emergency surgery to implant his first pacemaker on October 8, 1958. The device was a makeshift one: Time was short, forcing Elmqvist to mold the components in a simple plastic cup with synthetic resin. The pacemaker stopped working after just a few hours, and had to be replaced the following morning. The new unit worked perfectly for the next six weeks, however. Several months later, Elmqvist and Senning presented their work for the first time at an international conference in Paris focusing on the use of electronics in medicine. Elmqvist was still not convinced that his invention had a future, viewing cardiac pacemakers as “a technological curiosity, more or less”.
He was mistaken. His employer, Elema-Schönander (later Siemens-Elema) went on to develop numerous models featuring complex technology allowing them to be tailored to individual heart problems. For example, in today’s advanced systems, sensors analyze the body’s activity in real time and automatically adjust the impulse frequency accordingly. On average, some 75,000 of these devices are implanted each year in Germany alone.
Larsson went on to receive 25 more pacemakers in the 43 years following the first implantation. A pacemaker restored his ability to swim or cycle at a leisurely pace, dance, and even travel by plane. He was once again able to meet the demands of working life. Larsson held himself up as an example of how successful cardiac pacemakers could be, and successfully lobbied manufacturers to keep up their development activities. He died in 2001, aged 86, from causes unrelated to his heart problems or his pacemaker. Larsson even outlived Elmqvist, the man responsible for his extended lifespan, by around five years.