If you're math impaired or need some cultural points of reference, pacemakers were first invented before I Love Lucy went into syndication and they were in fairly widespread use before Richard Nixon, Helmut Schmidt, or Chairman Mao came to power.



Of course, the earliest pacemakers were really nothing like the small, compact, mini-computers that are in use today. The first pacemakers were large devices that could only supply small amounts of electricity to help force the heart to beat in a regular rhythm.

While modern pacemakers can last six, eight, even ten years or more, one of the very first devices implanted in a Swedish heart patient named Arne Larsson lasted just one day before the batteries conked out and the device had to be replaced. Mr. Larsson not only persevered through repeated operations in the early 1950s when technology was very basic, he became a lifelong advocate of implantable cardiac devices.

In fact, you could say the pacemaker was made for him. Actually, there were efforts in various locations in the early 1950s to find a way to build a pacemaker. It was known that a little bit of electricity delivered to the heart would force it to beat. It was also known that many people suffered from hearts that did not beat rapidly enough or reliably enough on their own. In Sweden, Arne Larsson had serious heart problems and his wife sought out an inventor to help create the product that could save him; together they worked tirelessly to come up with what could most charitably be called an "experimental device". The inventor was an engineer with the unusual name of Rvne Elmqvist, and it is reported that he built this first experimental device at home, in his kitchen.

Meanwhile, over in the United States, similar efforts were going on. A man by the name of Earl Bakken was also building a pacemaker based on plans he got out of Popular Mechanics for a metronome. The relationship between timing and pacing is important. Pacemakers not only have to give off electrical energy to help force the heart to beat, they have to do it in a precisely timed way. Pacemakers require precise timing circuitry to force the heart to beat in a healthful way.

The first major technological leap in pacemakers occurred when pacemakers stopped just pacing the heart to a preset rhythm and started to offer more "intelligent" therapy. Sensing is the function that allowed pacemakers to "listen" to the heart and literally record what the heart was doing on its own.

Pacemakers quickly adopted computer and microchip technology to add "brains," so that the pacemaker was equipped to listen to the heart, "make a decision," and then pace or not.Modern pacemakers monitor every beat of the heart and "fill in the missing beats" when the heart does not beat as it ought to. When nothing is needed, the pacemaker merely observes, content to be on stand-by.

Another major advancement in pacemakers occurred with the so-called transvenous lead. Transvenous means "through the vein," and lead is the standard term for the insulated wire that runs from the pacemaker (usually implanted in the upper chest) to the heart itself.

The first pacemakers required an open-heart procedure to implant the pacemaker, but it was not to put in the pacemaker itself. That part of the operation can actually be done under local anesthetic. The reason an open-heart surgery was required back then was that the lead had to somehow be connected to the heart.

In the first generations of pacemakers, the lead was sewn to the outside of the heart. This made pacemaker surgery a major operation and left a big scar.

A transvenous lead was designed to be inserted through a tiny incision in a vein (so tiny it can be done under local anesthetic) and then gently maneuvered into the heart and anchored on the inside of the heart.

With transvenous leads, pacemaker surgery became much faster and simpler. In fact, for many patients (depending on individual factors), pacemaker implantation can be done on an outpatient basis.

Today, pacemakers are getting smaller, smarter, and lasting longer. Modern pacemakers record every single beat of the heart and are prepared to send reports on the heart's activity to the doctor's office (and these reports are delivered in the form of printouts with graphs and tables!). Pacemakers today are programmable and can be set up to offer specialized therapy to meet individual needs.

The latest advancement involves what is being called "remote patient monitoring" or telemedicine. Using special equipment, a pacemaker patient can send information from the pacemaker to the doctor's office—from just about anywhere.

While remote patient monitoring is becoming increasingly sophisticated, pacemakers were actually some of the original devices to offer telemedicine. Even as far back as the 1980s, pacemaker people could send information from home to the doctor's office over a regular telephone. That technology is still around today, although with some refinements. In fact, pacemakers were some of the very first devices to introduce the whole concept of having a "check-up" with doctor and patient in two different locations!

The pacemaker business has changed a lot, but it is still going strong. In fact, companies that make pacemakers are more likely to call their product cardiac rhythm management devices or something like that, a catch-all term to refer to pacemakers, related devices, and accessories. Millions of people all over the world have benefited and continue to benefit from this life-enhancing therapy.

While finding out you need a pacemaker can be a big surprise and quite unsettling, most long-term pacemaker patients adjust well to having the device. Some even report that they more or less forget about it between check-ups.

While the "typical" pacemaker patient is a senior citizen, pacemakers are not uncommon in children. In fact, even newborns sometimes need them.Pacemakers are literally implanted in newborns one day old and in centenarians.