How it began
The Swedish cardiac surgeon Åke Senning was working on an implantable pacemaker with Rune Elmqvist, a physician and engineer at the Swedish company Elema-Schönander, later Siemens-Elema. They did not think the device was ready for human use. Then they met Arne Larsson, a 43-year-old engineer whose heart condition had become critical in the autumn of 1958. His wife Else-Marie persuaded them to implant the experimental device as a last attempt to save his life. Senning performed the operation on October 8, 1958, at the Karolinska Hospital in Stockholm.
Before it existed
Larsson's case shows what such patients faced. After a viral infection he had developed complete heart block. His heartbeat fell to 20 beats per minute, against 60 to 100 for a healthy heart, and he suffered frequent fainting spells, known as Stokes-Adams syndrome. He was collapsing 20 to 30 times a day and had to be resuscitated with blows to the chest each time.
How it works
A cardiac pacemaker treats a heart rate that is too slow by providing electrical stimulation to the heart. The 1958 device was self-contained and rechargeable, about the size of a hockey puck, and had just two transistors. Modern pacemakers can be as small as a half-dollar coin, can last up to 20 years and monitor the heart beat by beat so that they pace only when needed, but they rest on the same underlying principles as Elmqvist's original.
What changed first
The first unit failed almost at once. One account says it lasted three hours, another that it was damaged during the operation and stopped working after the first night. It was replaced with the only existing backup, an identical device. Elmqvist himself was reportedly not convinced that his invention had much of a future and called cardiac pacemakers a technological curiosity, more or less.
What lasted
Larsson lived a full and active life and received more than twenty further pacemakers as the technology advanced; sources give his total as 22 or 26. He died in 2001 at the age of 86 of an illness unrelated to his heart, having outlived both the inventor and the surgeon. Later advances in treating heart rhythm, including implanted defibrillators, grew out of the first pacing technology.
