50 years pacemaker

50 years ago, the first pacemaker was implanted in Germany

04.10.2011

The first implantation of a pacemaker in Germany dates back 50 years. Today over one million people in this country live with a pacemaker that regulates their heartbeat. On October 6, 1961, the young surgeon Heinz-Joachim Sykosch had decided contrary to the instructions of his boss for the implantation of the novel device in a 19-year-old accident victim. A bold step that paid off in the end.

Pacemaker pioneer performed over 8,000 procedures
As early as 1958, the world's first pacemaker was implanted, followed in 1961 by the first intervention in Germany. The now 86-year-old Heinz-Joachim Sykosch overreached his supervisor's will and successfully implanted a pacemaker at a 19-year-old accident victim at the Düsseldorf University Hospital. The patient survived the procedure and was able to get up shortly after the operation. Sykosch, on the other hand, was fired because of the arbitrary action, the 86-year-old pioneer told the news agency „dpa“. However, writes the doctor with the procedure history and was set back shortly thereafter. By the time of his retirement in 1990, Sykosch has implanted over 8,000 pacemakers, with more and more patients benefiting from the rapid pace of technological and medical development. Today's devices are hardly comparable with the pacemakers originally used and also Sykosch has a not inconsiderable share.

Pacemaker to treat slow heartbeats
Since the first implantation 50 years ago, pacemakers have been used to treat patients with slow beats (bradycardia), with devices that regularly stimulate the heart muscle with electrical impulses. In the run-up to the first implantation at the 19-year-old accident victim, the boss of Sykosch had declared that the doctor should „let the man die in peace“, so the statement of the pacemaker pioneer. However, Sykosch defied the guidelines, since he „from the development of a fully implantable pacemaker in the US“ would have. The doctor got the device and „it worked“. He has the same models in the coming years „implanted a few hundred more times“, reported Sykosch. This first pacemaker „weighed 240 grams, and the batteries lasted for about two years“, the brave pioneer continues. Hardly comparable to the modern cardiac pacemakers, which manage with a fraction of the original weight and the diameter of a coat button and whose batteries last eight to ten years, explained Sykosch.

Düsseldorf pacemaker pioneer contributes to the optimization
After he was hired again, Sykosch devoted himself as an assistant physician and the optimization of the recent pacemaker technique. Have him „disturbed that the pacemaker has beaten permanently, even if the patient himself had a proper pulse in between“, explained the pioneer. Therefore, Sykosch sat down in 1963 with a handful of tinkerers and developed the „R-wave simulator“, which only stimulates the heart muscle when it is actually needed. A technique subsequently with today „Demand“-Optimized pacemakers and helped to make the devices much more power efficient and last longer. However, since Sykosch and colleagues did not secure the patent, it is now owned by an American company. The Duesseldorf-based pioneer also played a key role in the development of today's standard, embedded in metal capsules batteries. All in all, hundreds of thousands of people probably owe their lives to the courageous and inventive actions of the pacemaker pioneer.

Pacemaker today a relatively safe, complication-free procedure
As the specialist in internal medicine and cardiology of the German Society of Cardiology, Prof. Berndt Lüderitz, in conversation with the news channel „ntv“ Today, around one million people in Germany and five million worldwide live with an implanted pacemaker. The pacemakers are used primarily to stimulate a pathologically slow pulse and above all „older people over 50, 60 years“ benefit from the technology, explained the expert. With the increase in life expectancy as a result of demographic change, the number of implanted pacemakers will continue to rise in the coming years, according to Prof. Berndt Lüderitz. Also, more and more clinics are in a position to perform a corresponding procedure and today, pacemaker implantations are performed in some 1,000 hospitals, sometimes even outpatient, said Lüderitz. In rare cases, children are also affected. As Sykosch reported, he implanted nine children with congenital heart disease with a pacemaker in the course of his activity, with the youngest patient just nine months old and „good today“ lives with her pacemaker.

50 years ago, the approach was to put the complete system under the skin without any external connection „really new“ and „a big breakthrough because people were not safe before“, explained Prof. Lüderitz. To date „had not grown against a too low heartbeat no herb“, the expert continues. After the world's first implantation in Stockholm was in 1958, followed in 1961, the first in Germany „from Sykosch, in cooperation with the cardiologist Sven Effert“, explained Prof. Lüderitz. However, the pacemaker implanted in Stockholm only lasted three hours, and the Dusseldorf patient also developed complications later. As reported by Sykosch, the two electrodes broke at the level of the ribs so that the pacemaker pioneer learned fine welding from a jeweler to repair the damage in another procedure. „I actually succeeded in welding the two ends together in another OP“, explained Sykosch. The patient, who was 19 years old at the time of his first intervention, reached the age of 45 and did not die of heart failure but of kidney disease, the expert continued. The procedure involved implanting a miniature battery-powered unit beneath the clavicle, from which electrodes pass through the veins into the heart where they stimulate the heart muscle. Just to change the batteries after a few years, a further small surgery is necessary, explained Prof. Lüderitz. „There used to be infections, inflammation or electrode fractures and much more. Today we have a very safe procedure with virtually no complications“, the expert continues. As the specialist in internal medicine and cardiology emphasized, is „The electrical pacemaker is a true success story because it leads previously untreatable people into a normal quality of life and a normal life expectancy.“ (Fp)

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Image: Explanted SSIR pacemaker from Guidant, source J. Heuser JHeuser