The Man Who Went Through 26 Pacemakers: How a Homemade Gadget Learned to Run the Human Heart

In the fall of 1958, Arne Larsson’s heart kept stopping.  He was a 43-year-old Swedish engineer, and a viral infection had left scars in the wiring that tells the heart when to beat.  His pulse sometimes dropped to 28 beats a minute, so slow that his brain ran short of blood and he blacked out.  On bad days it happened 20 or 30 times.  Each time, his wife, Else-Marie, or one of the hospital staff brought him back by thumping on his chest.  His doctors at the Karolinska Institute in Stockholm could not say which collapse would be the last.

Else-Marie had read that a surgeon at the same hospital, Åke Senning, was working with an engineer named Rune Elmqvist on an electrical pacemaker small enough to sew inside the body.  It had only been tried on animals.  She kept after them, by most accounts every day, until they agreed to try it on her husband.  On October 8, 1958, in an operation kept quiet at the time, Senning opened Larsson’s chest, attached two electrodes to his heart, and tucked a battery-powered device about the size of a hockey puck under his skin.

It stopped working after about three hours.  Senning put in the backup, the only other one they had.  Larsson went on to live another 43 years, and over that time he went through 26 pacemakers, each one smaller and smarter than the last.  He outlived both the engineer and the surgeon who saved him.  Our recent piece on deep brain stimulation explained how doctors borrowed the name “pacemaker” for a device that calms tremors in the brain.  This is the story of the original, and of how a handful of engineers, a wrong resistor, and a power failure in Minneapolis turned it into something about a million people receive every year.

The heart’s own spark plug

Every heartbeat starts with a tiny electrical signal.  It comes from a small patch of tissue in the wall of the upper right chamber called the sinoatrial node, the heart’s natural pacemaker.  The signal spreads across the two upper chambers, squeezing them, then passes through a relay point called the atrioventricular node, which hands it down to the two big pumping chambers below.  In a healthy adult at rest, this happens 60 to 100 times a minute without any thought at all.

Larsson’s problem was a break in that relay, a condition called heart block.  When the signal from above can’t get through, the lower chambers fall back on their own backup rhythm, which is slow and unreliable.  The sudden faints it causes are called Stokes-Adams attacks, after two Irish doctors who described them in the 1800s.  Before pacemakers, a severe case was often a death sentence.  By one estimate, patients with complete heart block had perhaps a 50 percent chance of living more than a year.

Doctors had known for a long time that electricity could jolt a stalled heart.  In 1889 a Scottish physiologist, John Alexander MacWilliam, reported that regular electrical pulses could make a human heart beat at 60 to 70 times a minute.  In 1932 an American doctor, Albert Hyman, built a hand-cranked machine to restart hearts and called it an “artificial pacemaker,” the name that stuck.  But the public was uneasy about machines that seemed to revive the dead, and Hyman never published his results in people.

Machines on carts, plugged into the wall

The first practical pacemakers, built in the early 1950s, were big boxes on carts.  In 1950 a Canadian engineer, John Hopps, built a vacuum-tube unit for surgeons in Toronto.  Starting in 1952, a Boston cardiologist named Paul Zoll paced patients through electrodes on the skin of the chest.  That kept people alive, but the shocks were strong enough to hurt and to make the chest muscles jump.  And because these machines ran on wall current, a patient could be electrocuted, and a power cut could stop the pacing.

That last danger turned into a tragedy.  In Minneapolis, a surgeon named C. Walton Lillehei was repairing heart defects in children, and the surgery sometimes damaged the heart’s wiring, so his young patients needed pacing while they healed.  On October 31, 1957, a power blackout hit the city, and one of Lillehei’s small patients died.  The next day he asked Earl Bakken for help.  Bakken was an electrical engineer who repaired hospital equipment out of a garage, in a little company he had named Medtronic.

Bakken found a circuit for an electronic metronome in Popular Electronics magazine and adapted it, using the new transistors that had gone on sale a couple of years earlier.  About four weeks later he delivered a battery-powered pacemaker roughly the size of a few decks of cards.  He thought he had handed over a lab prototype.  When he came back the next day, he found it already strapped to a child.  There was no device approval process to slow things down.  The U.S. Food and Drug Administration didn’t start regulating medical devices until 1976.

Inside the body, inside a cup

Bakken’s pacemaker was still worn outside the body, with wires running through the skin to the heart, which risked infection.  In Stockholm, Elmqvist and Senning were trying to put the whole thing inside.  Elmqvist was a physician who had switched to engineering and worked for the electronics company Elema-Schönander, later part of Siemens.  His design used two transistors and a pair of rechargeable nickel-cadmium batteries, which were topped up through the skin with a coil, a little like a modern wireless phone charger.  It fired a pulse about 70 times a minute.

There was no time for elegant packaging.  To get a device ready for Larsson, Elmqvist cast the parts in epoxy resin, using a plastic cup as the mold.  Some retellings say it was a shoe-polish tin.  Either way, the result looked homemade, and Elmqvist himself was not convinced it had much of a future.  He later called pacemakers “a technological curiosity, more or less.”  Senning, for his part, refused to patent the work.  “Medical discoveries belong to the patients and not to the inventor,” he liked to say.

The wrong resistor

Meanwhile, in Buffalo, New York, an engineer named Wilson Greatbatch had his own breakthrough by accident.  In 1956 he was building a circuit to record fast heart sounds for a medical research institute.  He reached into a box for a resistor and grabbed one of the wrong size.  When he switched on the circuit, it didn’t record anything.  Instead it gave off a short pulse, paused for about a second, and pulsed again, over and over.  Greatbatch recognized the rhythm of a beating heart.

He spent the next two years shrinking that circuit, much of the time in a barn behind his house, using his own savings.  On May 7, 1958, surgeons William Chardack and Andrew Gage at the Buffalo Veterans Administration hospital exposed the heart of a dog, and Greatbatch touched his device’s two wires to it.  The heart fell into step.  “I seriously doubt if anything I ever do will ever give me the elation I felt that day when my own two-cubic-inch piece of electronic design controlled a living heart,” he wrote in his diary.

In 1960 Chardack’s team implanted Greatbatch’s pacemaker in ten patients with complete heart block, two of them children.  Unlike the Swedish design, it ran on mercury batteries that didn’t need recharging, all sealed in epoxy.  The first patient, a 77-year-old man, lived another 18 months.  Another was a young man who had collapsed on the job at a local rubber factory.  After his implant he retrained as a hairdresser and lived for 30 more years.  Greatbatch licensed the design to Bakken’s Medtronic, which began making it, and the implantable pacemaker became a product.

Batteries were the weak spot

The early implants had two big problems.  The first was power.  Mercury batteries wore out fast, often in about a year, and every replacement meant another operation.  That is a big part of why Larsson needed so many devices.  The second was moisture.  Body fluids slowly seeped through the epoxy and damaged the electronics.  The fix for that turned out to be a sealed metal case.  An Australian company, Telectronics, introduced hermetically sealed pacemakers in 1969, and by the mid-1970s titanium cases had become the standard.

For a while, one answer to the power problem was nuclear.  In the late 1960s, researchers in the United States and France developed pacemakers powered by a tiny pellet of plutonium-238, which gives off steady heat that can be turned into electricity.  A French team reported the first human implant in 1970.  The pellet was sealed in a case built to survive a bullet or a cremation, and the devices were designed to run for ten years without surgery.  Some lasted thirty.  But regulators worried about plutonium circulating in the public, and about what would happen if a body was cremated with one inside.  As of 2003, an estimated 50 to 100 Americans still carried one.

The winner was lithium.  In the early 1970s Greatbatch adapted a lithium-iodine battery that other researchers had dismissed because it could only deliver a tiny current.  A pacemaker needs only a tiny current, so it was a perfect match.  Cardiac Pacemakers Inc., a Minnesota startup, built some of the first pacemakers around it.  The battery even has a built-in warning.  As it runs down, a layer of lithium iodide grows inside it and its voltage slowly drops, so doctors can see the end coming months ahead.  Lithium cells stretched pacemaker life from about a year to as long as a decade.  (Lithium chemistry has come a long way since; our explainer on LiFePO4 batteries covers one of today’s workhorses.)

Through a vein, and on demand

The surgery got easier, too.  Early implants meant opening the chest to stitch electrodes onto the outside of the heart.  In 1959 two New York doctors, Seymour Furman and John Schwedel, showed that a wire could instead be threaded through a vein into the heart from inside.  By the mid-1960s that became the standard way to place pacemaker leads, and today the operation usually takes about an hour under local anesthetic, with the device sitting in a small pocket under the skin below the collarbone.

The devices also got smarter.  The first ones fired at a fixed rate no matter what the heart was doing, which could clash with the heart’s own beats.  Modern pacemakers are “on demand.”  They listen to the heart and fire only when it misses a beat or slows down too much.  Many have sensors that speed up the rate when you climb stairs, and doctors can adjust their settings wirelessly through the skin.  The same basic idea, a small battery-powered box that sends timed pulses down a wire, now runs cochlear implants, deep brain stimulators, and the brain-computer interfaces that make headlines today.

No wires at all

For most of their history, the weakest link in pacemakers was literally the link, the wire lead that runs from the device to the heart.  Leads can crack, slip, or get infected, and removing an old one can be tricky.  So engineers eventually got rid of them.  In April 2016 the FDA approved the Medtronic Micra, a self-contained pacemaker about an inch long.  A doctor guides it up through a vein in the leg on a catheter and anchors it inside the heart’s lower right chamber with tiny tines.  There is no pocket under the skin and no lead.

The first leadless devices could pace only one chamber, but most people who need a pacemaker need two, the upper and lower chambers working in sync.  In 2023 the FDA approved Abbott’s AVEIR DR, a pair of leadless pacemakers, one in each chamber, that talk to each other on every beat.  According to Abbott, more than 80 percent of pacemaker patients need that kind of two-chamber pacing.

New problems for a 68-year-old invention

Connecting pacemakers to the outside world has brought its own risks.  In 2017 the FDA approved a firmware update for hundreds of thousands of pacemakers made by St. Jude Medical, by then part of Abbott, after security researchers found that someone nearby with the right equipment could, in theory, send them unauthorized commands, drain the battery, or change the pacing.  No attacks were reported, and the fix took about three minutes in a doctor’s office.  But it was a striking moment, a recall of a heart implant handled like a software patch.

There is also the question of what happens afterward.  Pacemakers are removed from bodies before cremation because their batteries can explode in the heat.  Many still have years of power left, and researchers and charities have studied whether these devices can be safely cleaned and given to patients in low- and middle-income countries, where a new pacemaker is often out of reach.

Arne Larsson saw almost the whole arc.  He started with a hand-cast epoxy disc that needed a recharging coil and ended with compact titanium units that ran for years.  He became an advocate for other patients, pushing for better funding and care, and he died at 86 in December 2001, from melanoma, not his heart.  Åke Senning had died the year before, and Rune Elmqvist in 1996.  Larsson’s wife had refused to accept that her husband’s heart was beyond help, and she happened to be right about something nobody else was sure of yet: that a little box of electronics could keep a person alive for decades.

Keep an eye on your own heart rhythm