The first pacemaker in Warsaw, and the second in Poland, was implanted 50 years ago in the Department of Internal Diseases of the Medical Academy of that time (now the Medical University of Warsaw) – recalled Dr. n. med. Marcin Grabowski.
On this occasion, an exhibition of pacemakers and cardioverter defibrillators was opened in the Department of Cardiology of the Medical University of Warsaw, which continues the tradition of the former Internal Medicine Clinic, which have been implanted in patients in the last 50 years. One of its organizers is Stefan Olempski, a technician at the Department of Cardiology, who participated in the first pacemaker implantation procedure in Warsaw.
The procedure was performed at the end of 1965 at the Infant Jesus Hospital at ul. Nowogrodzka in Warsaw, where the Internal Medicine Clinic was located at that time. Its head was prof. Zdzisław Askanas, president of the Polish Cardiac Society and the first national consultant in the field of cardiology.
At that time, the second pacemaker implantation in Poland was performed in Warsaw. The first such procedure was performed in 1963 in Gdańsk by prof. Zdzisław Kieturakis and Dr. Wojciech Kozłowski. Five years earlier, on October 8, 1958, the Swedish cardiac surgeon Dr. Ake Senning implanted a pacemaker in Arne Larsson for the first time in the world. The Swede lived 86 years, died in 2001, had as many as 24 next-generation stimulators implanted (Dr. Senning died earlier from him).
The Warsaw exhibition presents all the most important types of stimulators that have been used in the world in the last half century. The first pacemakers, also called pacemakers, were mercury-powered. They were made of metal elements, and then of titanium, but embedded in resin. The only “plastic” starters were produced by the Czechoslovakian company Tesla at that time, but only a few such copies were delivered to Poland in the 70s.
The first starters were quite heavy, weighed 140 grams, and only worked for two years. They were 2,5 cm thick. They were emergency – when the resin cracked, they stimulated the heart too quickly, which was dangerous for the patient. In the second half of the 70s, the lifetime of these cameras was extended to 5 years, which was a huge improvement.
The exhibition also shows a dummy nuclear stimulator, which theoretically could work for 30 years. They were powered by a platoon. The electrodes were less durable, therefore their service life was estimated at over 15 years. They were large and complicated, they produced a high internal temperature, reaching even 300 degrees C. They cost 6 to 7 thousand. dollars.
In Poland, only 4 nuclear stimulators have been implanted. The first on July 27, 1974 was received by a 14-year-old girl. The procedure was performed at the XNUMXth Department of Internal Diseases in Warsaw.
In the second half of the 70s, a new generation of pacemakers was started to be used, equipped with lithium batteries, which extended their service life. They were able to work for 7-10 years. In 1972, they were used for the first time in Italy, not in the USA, and then quickly began to displace mercury-based stimulators. They became more reliable and weighed only 50-70 grams.
“These devices are now much smaller, lighter and safer for patients, and their implantation has become less complicated and does not require opening the chest” – explains Dr. Marcin Grabowski. The newest stimulators have box sizes of 3 by 4 cm, weigh only 21-31 grams, and their service life is estimated at several years.
Treatments are performed under local anesthesia. The pacemaker is implanted subcutaneously, usually below the left collarbone. The electrodes are introduced intravascularly – through the venous vessels. The device has advanced functions: it is possible to program its frequency and methods of assessing the patient’s activity, it also allows to recognize disturbing heart conditions, e.g. arrhythmia.
According to Dr. Grabowski, in the past, stimulators reacted badly to the magnetic field, which could even turn them off. Currently, devices are implanted that enable the patient to perform magnetic resonance imaging. They are reliable, sometimes there is only damage to the electrodes. To ensure the patient’s safety, an additional telemonitoring device is used, which allows for early intervention in critical conditions.
In the past, pacemakers were implanted only in patients who could not survive without them. Today, more and more procedures are performed to improve the quality of life, and the indications for implantation are becoming wider. They are performed in patients at high risk of developing disorders.
One of the newest devices implanted in patients in the cardiology clinic of the Medical University of Warsaw are the so-called syncope recorders. Thanks to them, it is possible to determine why the patient experiences e.g. sudden, repeated fainting. Traditional methods such as the holter do not record them.
“We had a patient in whom doctors, family and friends suspected epilepsy. Other symptoms indicated heart problems. We implanted him with an event recorder. After two months the patient lost consciousness again. It turned out that his heart stopped for 15 seconds! The implanted recorder immediately registered the event, made it possible to diagnose syncope and therefore solved the patient’s problem “- recalls Dr. Grabowski.