It is 50 years since pioneering surgeons performed the first implant of a battery-operated artificial device in a cardiac patient, writes BRIAN MAYE
THE HEART pacemaker is a life-saving and life-enhancing device that is taken so much for granted nowadays that it is easy to forget that it is only 50 years since the first fixed-rate artificial device, with a five-year mercuric-oxide battery, was implanted in a patient on June 6th, 1960.
This pioneering development in medicine was the culmination of experimentation that went back to the end of the 19th century.
In 1899, JA McWilliam reported in the British Medical Journalhow he had applied an electrical impulse to a human heart that had stopped which caused a ventricular contraction.
In 1926, doctors in Sydney devised a portable apparatus that could be plugged into a lighting point, with one pole applied to a skin pad soaked in a strong salt solution while the other pole consisted of a needle, insulated except at its point, which was plunged into the appropriate chamber in the heart.
This produced a heart rate which varied from 80 to 120 beats a minute. The apparatus was used to revive a stillborn baby and, after 10 minutes’ stimulation, the baby’s heart continued to beat of its own accord. The apparatus was referred to in the medical journal write-up as “the first pacemaker”.
Albert Hyman, in 1932, came up with a device that was powered by a spring-wound, hand-cranked motor. He called his invention an “artificial pacemaker”, a description that is used to the present day.
But in the decade before the second World War, there seemed to be a public unease about “reviving the dead”, which led to the lack of publication of research.
Hyman did not publish data on the use of his pacemaker in humans because of criticism from both his fellow doctors and the media and this may have been why the Sydney doctors (Mark Lidwell and Edgar Booth) did not continue their experimentation.
The next step forward came in 1950 when a Canadian electrical engineer, John Hopps, made an external pacemaker under the guidance of cardiovascular surgeon Wilfred Bigelow at Toronto General Hospital.
It was a fairly big device using vacuum tube technology to deliver pulses of electric current through the patient’s chest during a medical emergency. It caused the patient pain and, because it was powered from a wall socket, could lead to electrocution. Innovations on this device made it smaller and powered it by a large rechargeable battery.
In 1957, Dr William Weirich reported on experiments on animals using a myocardial electrode. By this time the silicon transistor had been developed and this led to marked progress in practical cardiac pacemaking.
The first wearable external pacemaker (battery operated and transistorised) was developed by US electrical engineer Earl Bakken, also in 1957. It was in a small plastic box, had controls to adjust the pacing of the heart rate, and electrode leads which went through the patient’s skin and ended in electrodes attached to the wall of the heart.
The first clinical implantation of a pacemaker into a human took place in 1958 at the Karolinska Institute in Sweden. Designed by Rune Elmqvist and Ake Senning, it connected to electrodes attached to the myocardium by thoracic incision.
The device failed after three hours and was replaced by a second, which lasted two days. The patient, Arne Larsson, was given 26 different pacemakers during his lifetime and died in 2001, aged 86.
The American cardiothoracic surgeon, William Chardack, had carried out research into heartbeat problems from the mid-1950s onwards. The team he led, an important member of which was engineer Wilson Greatbatch, first experimented on successfully pacing dogs’ hearts before applying the same technology (low-current drain transistorised pulse generators driven by mercury cells) to humans.
The use of the mercury battery was the innovation that varied from the Swedish devices.
Further development and refinement followed, notably Greatbatch’s lithium-iodide battery and transvenous pacing. The combined efforts of the courageous and innovative doctors and engineers referred to in this article have enabled countless numbers of people to live normal and fulfilled lives.
