In 2012  I was completing a continuing medical education course and came across the story of the first implantable pacemaker. It happened in 1958 at the Karolinska hospital in Stockholm, Sweden. This was at the tail end of a decade that is considered the golden age of cardiothoracic surgery when pioneer after pioneer introduced new techniques and devices, and developed treatments for heart conditions that used to be incurable.

The pacemaker story caught my attention because of the circumstances surrounding how the first device was created. The story involves Arne Larsson, a 42 year-old self-made businessman who was suffering from multiple fainting spells a day because of extremely slow heart rates. He eventually ended up at the Karolinska hospital where he stayed for months as the doctors tried every remedy available – including whiskey (see separate article) – but none of the treatments really helped. His initial collapse happened in March 1958, and by September he was considered terminal. He was not expected to survive for very long.

Arne was a robust and very active man. He played a form of hockey with the Swedish team, hiked the Swedish mountains, and skied down its slopes. He had a beautiful wife, Else-Marie; and two young children, Bjorn and Malou. He had built a company that provided electrical services for merchant ships. In the post World War II era, the shipping industry in war-spared Sweden was quite frantic, and business was booming for Arne. 

Else-Marie was crushed when the doctors finally told her that they could offer nothing else for Arne. They told her that they had tried everything.

During a typical business trip to one of the shipping harbors, Arne dined in a popular seafood restaurant and ordered oysters. Unfortunately, he became one of hundreds of victims of hepatitis caused by tainted oysters. This led to an inflammation of his heart that damaged the conduction system, causing severe heart blocks and the dangerously slow heart rates.  Else-Marie was crushed when the doctors finally told her that they could offer nothing else for Arne. They told her that they had tried everything.

I was able to speak with 90 year-old Else-Marie about a year ago. Her memory remained remarkably sharp as she generously relayed the story to this stranger calling from the U.S. about an event that occurred almost sixty years ago. The previously published accounts of this story tell of Else-Marie discovering that doctors at the Karolinska were actually conducting research on pacemakers during the time when Arne was sick. She then proceeded to pester the doctors to make the pacemaker and save her husband’s life.

Senning told her about the experiments that they were conducting on dogs, using a battery-powered pacemaker

I asked Else-Marie how she first learned about the pacemaker. She laughed and said she found out while she was at the hair salon. In between staying with Arne at the hospital and caring for the kids (who thought their dad was on a business trip), she managed to find some time for herself. At the salon, she picked up an American magazine and saw an article about a little girl being connected to a pacemaker following heart surgery. It was in a hospital somewhere in Minnesota. She had no idea that such device even existed. She made up her mind to bring Arne to America. She then sought out Dr. Senning, the prominent cardiac surgeon, to discuss this option. Senning told her that Arne would never survive the trip. Once again, Else-Marie felt crushed. It was then that Senning told her about the experiments that they were conducting on dogs, using a battery-powered pacemaker. He even brought her to the hospital yard where Else-Marie saw the canines with little parcels on their backs.

A unit that is completely embedded with no external wires was still unavailable. They did not even have a prototype

Else-Marie realized that the technology was available right there at the Karolinska. She told Senning that he must give Arne a pacemaker. Senning refused, saying that they were far from completing their experiments on implantable pacemakers. The pacemakers available at the time were external units with wires connected to the heart. Senning told her that they were encountering major problems with infections. A unit that is completely embedded with no external wires was still unavailable. They did not even have a prototype. Else-Marie was undeterred and pestered Senning for days until he finally relented. The pacemaker was actually created by Dr. Rune Elmquist – a physician and self-taught engineer who fashioned the first prototype using a Kiwi shoe polish can as a mold.

On October 8,1958, sometime in the evening when the surgical suites were quiet, Senning and his team wheeled Arne into the operating theater and implanted the first self-contained pacemaker. It only lasted a few hours. The next morning, Arne underwent another first – the first implantable pacemaker replacement in history. This time the unit worked, at least for a few weeks.

 Arne became very involved in early educational programs teaching patients as well as doctors about the new device. As a frequent traveler, he realized the difficulty of dealing with confused airport officials or doctors in a different country who had no experience with the technology. He was the president of a foundation that advocated for heart patients and provided tools and support for people receiving the intimidating devices. He went back to running his business, underwent multiple pacemaker changes in his lifetime, and lived a full life. He died in 2001 when he was 84 years old.  He even outlived both Senning and Elmquist. The cause of death was related to skin cancer. His last pacemaker was working just fine.

 

 

 

 

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