Pacemakers: from the size of a typewriter to the size of a matchbox

Different types of pacemaker used over the years.
Different types of pacemaker used over the years. / SUR
  • The Hospital Regional in Malaga has so far implanted 10,000 of these devices into heart patients

Pacemakers are devices which prevent the heart stopping. Their function is to save the lives of people who would die if they didn't have them. Malaga's Hospital Regional (formerly Carlos Haya) has implanted more than 10,000 pacemakers since the first one in 1975.

The way these devices have evolved has been spectacular, and their size has changed. Once as big as a typewriter, they are now as small as a box of matches. As well as the conventional types, there are more complex versions (defibrillators and resynchronisers) which are fitted in some patients. Pacemakers can be double or single chamber and even wireless.

Every year the regional hospital carries out about 250 new implants and, in addition, 50 to 60 re-implants to change a device's battery. This normally needs to be done after ten years.

Eighty per cent of patients who are fitted with a pacemaker are over the age of 75 and suffer from a degeneration of the cardiac conduction tissue (the nerves of the heart) which causes a blockage in the cardiac activity and, as a result, a slowing-down which can lead to cardiac arrest. The head of cardiovascular surgery at the Regional, Fernando Calleja, fitted a 105-year-old with a pacemaker, and the man wrote him a poem in thanks.

The first pacemakers began to be fitted at the Carlos Haya hospital by Dr Antonio Moncada in 1975, although the cardiovascular surgical department was not set up until 1980 and was run by Norberto González de Vega.

The fact that 10,000 pacemakers have now been fitted at the hospital was marked with a press conference this week, with regional Health and Families delegate Carlos Bautista; hospital manager Víctor Baena; the head of the heart unit, Manuel de Mora; the above-mentioned Fernando Calleja, and Esther López, the supervisor of the cardiac surgical ward.

"For us it is a matter of pride and satisfaction to have reached the 10,000 figure," said Victor Baena. Carlos Bautista also explained that people who receive these pacemakers normally live for many more years.

A series of tests are carried out before doctors decide whether a patient needs a pacemaker. Dr De Mora said that the problems are normally detected by cardiologists, but sometimes by GPs or doctors in emergency and intensive care units, among others.

Manuel de Mora praised the skill and experience of the cardiac surgeons at the hospital.

Fernando Calleja explained that although the technique of fitting a pacemaker is relatively straightforward and there are few complications, it can be more complex in some patients because of their age.

The process consists of introducing, through a vein close to the heart, a wire coated with silicon which has an electrode at one end and is placed in contact with the heart (right ventricle). When connected to an electrical battery, it emits electric impulses which stimulate cardiac contraction and return the heart's normal function.

The procedure is carried out under local anaesthetic, while the patient is awake. If there are no complications, he or she is able to go home after 24 hours.

At the press conference, Esther López also pointed out that nursing staff play an important role by answering patients' questions as well as providing all the care they need.