Imagine the engine of a car - it does not only need fuel to run, but also sparking plugs to kick it into action. The heart is similar - coronary arteries take blood to the heart similarly to fuel being pumped into a car engine. But the heart also needs an electrical system to work properly, and in fact, as cardiologist Oscar Aquilina explains, wires made out of flesh conduct an electric impulse from the upper to the lower chambers of the heart.
It is only then that the heart can beat properly and blood is circulated around the body.
But sometimes the wires get diseased and stop passing the electricity through the heart.
"You can have a perfectly good engine and a good fuel system, but if there is a problem with the sparking plugs or the wires, the engine will not work."
The heart then slows down and the patients suffer a multitude of symptoms, including dizzy spells and even loss of consciousness since the brain will be starved from the necessary amount of blood and oxygen.
When the heart's electrical system fails, patients need an outside force to help the heart continue beating at the optimal rate.
"A pacemaker is an electronic device which controls the heart rate, stopping it from going too slow."
Every year some 200 new people get a pacemaker implanted in Malta, and between 40 and 50 are changed. Although the ages of patients vary greatly - with the youngest being just two months old and the oldest past his 98th birthday - the majority of patients are elderly. "Younger patients normally need a pacemaker following a cardiac operation."
The first pacemaker was implanted in a Maltese patient in 1976 in the UK and Dr Aquilina says that the first implantation in Malta took place in the early 1980s.
He continues that pacemakers do not normally have an impact on the patient's lifestyle, with most continuing with their day-to-day life as before.
"But although the physical lifestyle does not change, patients have to take a psychological leap and realise that their heart has a problem. Some accept it immediately, while others take longer."
Pacing history
The need for pacemakers started being felt in the mid-1950s, mainly pushed forward by cardiac surgeons who used to operate on babies with congenital heart disease.
"Many times, during surgery they would have somewhat damaged the heart's wiring system, with the heart stopping as a result. This meant that all their precise surgery work would have been useless," Dr Aquilina says, adding that most patients needed support only for a short time until the heart recovered and started to beat normally again.
Back then technology was still very far behind, and the only thing they could come up with was a very big mains-powered valve stimulator. The next step was a modified electronic metronome, which was attached to the patient with wires going through the skin into the heart.
"This was clearly a solution, but not the answer since there were still wires coming out of the body. So the race for the first implantable pacemaker was still ongoing with people on both sides of the Atlantic trying to get there first."
Then came Else Marie Larsson, whose husband Arne was hopelessly ill and fainting several times a day with heart block. She was pleading with surgeons to help her out, asking for what at the time was the impossible - an implantable pacemaker.
And she got her way because electrical engineer Rune Elmqvist used a shoe-polish tin as a mould to create the first pacemaker. Renowned cardiac surgeon Ake Senning then implanted it in Mr Larsson on October 8, 1958 at Stockholm's Karolinska Hospital.
Unfortunately, the first pacemaker had a short-lived life - it failed after just three hours. A second device was put in and lasted for two days. Mr Larsson used 26 different pacemakers until he died in 2001 of a malignancy which was totally unrelated to his heart condition.
"Initially pacemakers were life-saving devices, and nobody cared about making them fancy. But as technology improved, they became even more intelligent."
In fact, Dr Aquilina explains, today's pacemakers can change the heart rate as a person exercises.
"If we set the pacemaker to give a person a standard fixed heart rate of 60 beats per minute, it would be good for him at rest, but not when he exercises since the heart will need to beat faster. Today's pacemakers recognise that the patient is exercising and gives him a higher heart rate."
Another important improvement was the introduction of dual chamber pacemakers which control both the upper and lower chambers of the heart.
A major advance was the introduction of a small radio receiver inside the pacemaker, allowing the doctor to use an external device to communicate with the pacemaker across the patients' skin. "This allows doctors to modify the pacemaker's parameters, like the pacing rate, and also check the output of the equipment."
But over the years there have also been some technological dead-ends with Dr Aquilina mentioning a rechargeable pacemaker and a nuclear-powered one. Dr Aquilina explains that pacemakers work on lithium batteries, allowing them to last between six and eight years, which is good news for patients since they have to undergo surgery every time the pacemaker needs to be changed.
Today's pacemakers are also extremely small, but since they are implanted just under the skin on the upper chest, they still show in patients who are very thin. However, there have been a number of female patients who had their pacemaker implanted under the breast, where it does not show at all.
The history of pacing is interesting and indebted to many individuals who believed the impossible and set out to accomplish it. Pacemakers have developed from simple life-saving devices to tools that improve the quality of life, Dr Aquilina said.
Pacemaker patients personal stories
Name: James Camilleri
Age: 75
Date of first pacemaker: 1975
Thirty-three years ago, James Camilleri, then 42 years old, started fainting regularly.
"My pulse rate slowed down dramatically and I used to fall down on a regular basis. I would be walking normally and all of a sudden find myself on the ground as if someone had pushed me. But the moment I touched the ground, I would wake up again."
He was sent to a cardiologist who soon realised Mr Camilleri was in need of a pacemaker. "I did not even know what a pacemaker was," he said candidly.
Mr Camilleri was sent to London's St Mary Hospital to have the surgery, and admits he did not understand the English-speaking doctors all that well. "I barely knew what was happening."
His road to recovery came with some hiccups since a piece of equipment was missing. "I was sent back home and told that they would operate me again once a visiting professor came to Malta."
Mr Camilleri's life has changed drastically. "Before I could barely do anything that meant exerting myself. Even if I went walking, I would soon be out of breath. But after 15 days following the operation, I went swimming and have not looked back since.
I even used to take care of a piece of agricultural land." He has changed the pacemaker five times and today's model is much better than the first one he had implanted. "That one had batteries on the outside, which I used to have to change myself. It was pretty annoying. The modern ones are much more convenient."
Name: Joseph Sansone
Age: 59
Date of first pacemaker: 1980
When he was just 17 years old, Joseph Sansone had to be taken to the UK for open heart surgery to mend a hole in his heart. His life changed drastically, and from a sickly youngster, he started living a normal life.
Roll on a few years, and when he was in his early 30s he suffered a heart failure. "I was in the car after giving a lift to a friend. I did not feel anything, but my heart stopped and I crashed into the car in front of me.
"The moment they moved me I regained consciousness, and was rushed to hospital."
After a spate of tests, Mr Sansone was told he needed a pacemaker. "The moment I realised that I was going to be operated upon again, I fainted."
But once the pacemaker was put in place, his life went back to normal.
"My life did not change from before I had the pacemaker implanted, because I was only ill for a few hours. The biggest change was felt when I had surgery at 17 - before I used to get tired constantly, turn blue whenever I exert myself and feel extremely cold in winter."
Mr Sansone has had the pacemaker changed about five times. Does the scar annoy him? He admits that compared to the surgery scar, it is very small.
Name: Joe Borg (name changed)
Age: 30
Date of first pacemaker: 2005
When Joe Borg went to work one day in May 2005, nothing seemed out of the ordinary. But just a few hours later, he fainted while walking through the reception of the office building, losing consciousness for about a minute.
After six days in hospital, doctors detected a weak pulse and told him that he needed a pacemaker.
"At first I was stunned, but I have since learned to live my life with it. To be honest, it does not bug me at all."
He admits to never having felt that anything was amiss before the incident at work. "All was normal before, and all went back to normal after the surgery."
In fact, he admits to pushing himself to the limit, especially when working long hours, although he does not engage in contact sports and steers clear of body scanners.
"The doctors had suggested that I try not to exert myself, but shortly after surgery there was a big match between Liverpool and Milan, which ended in penalties. As an avid Liverpool supporter, I could not miss it, and did get quite a bit excited."
He said that although patients are sometimes worried about having a pacemaker implanted, they should not be because it allows them to have a better life. And it barely shows, he continued.
It is only then that the heart can beat properly and blood is circulated around the body.
But sometimes the wires get diseased and stop passing the electricity through the heart.
"You can have a perfectly good engine and a good fuel system, but if there is a problem with the sparking plugs or the wires, the engine will not work."
The heart then slows down and the patients suffer a multitude of symptoms, including dizzy spells and even loss of consciousness since the brain will be starved from the necessary amount of blood and oxygen.
When the heart's electrical system fails, patients need an outside force to help the heart continue beating at the optimal rate.
"A pacemaker is an electronic device which controls the heart rate, stopping it from going too slow."
Every year some 200 new people get a pacemaker implanted in Malta, and between 40 and 50 are changed. Although the ages of patients vary greatly - with the youngest being just two months old and the oldest past his 98th birthday - the majority of patients are elderly. "Younger patients normally need a pacemaker following a cardiac operation."
The first pacemaker was implanted in a Maltese patient in 1976 in the UK and Dr Aquilina says that the first implantation in Malta took place in the early 1980s.
He continues that pacemakers do not normally have an impact on the patient's lifestyle, with most continuing with their day-to-day life as before.
"But although the physical lifestyle does not change, patients have to take a psychological leap and realise that their heart has a problem. Some accept it immediately, while others take longer."
Pacing history
The need for pacemakers started being felt in the mid-1950s, mainly pushed forward by cardiac surgeons who used to operate on babies with congenital heart disease.
"Many times, during surgery they would have somewhat damaged the heart's wiring system, with the heart stopping as a result. This meant that all their precise surgery work would have been useless," Dr Aquilina says, adding that most patients needed support only for a short time until the heart recovered and started to beat normally again.
Back then technology was still very far behind, and the only thing they could come up with was a very big mains-powered valve stimulator. The next step was a modified electronic metronome, which was attached to the patient with wires going through the skin into the heart.
"This was clearly a solution, but not the answer since there were still wires coming out of the body. So the race for the first implantable pacemaker was still ongoing with people on both sides of the Atlantic trying to get there first."
Then came Else Marie Larsson, whose husband Arne was hopelessly ill and fainting several times a day with heart block. She was pleading with surgeons to help her out, asking for what at the time was the impossible - an implantable pacemaker.
And she got her way because electrical engineer Rune Elmqvist used a shoe-polish tin as a mould to create the first pacemaker. Renowned cardiac surgeon Ake Senning then implanted it in Mr Larsson on October 8, 1958 at Stockholm's Karolinska Hospital.
Unfortunately, the first pacemaker had a short-lived life - it failed after just three hours. A second device was put in and lasted for two days. Mr Larsson used 26 different pacemakers until he died in 2001 of a malignancy which was totally unrelated to his heart condition.
"Initially pacemakers were life-saving devices, and nobody cared about making them fancy. But as technology improved, they became even more intelligent."
In fact, Dr Aquilina explains, today's pacemakers can change the heart rate as a person exercises.
"If we set the pacemaker to give a person a standard fixed heart rate of 60 beats per minute, it would be good for him at rest, but not when he exercises since the heart will need to beat faster. Today's pacemakers recognise that the patient is exercising and gives him a higher heart rate."
Another important improvement was the introduction of dual chamber pacemakers which control both the upper and lower chambers of the heart.
A major advance was the introduction of a small radio receiver inside the pacemaker, allowing the doctor to use an external device to communicate with the pacemaker across the patients' skin. "This allows doctors to modify the pacemaker's parameters, like the pacing rate, and also check the output of the equipment."
But over the years there have also been some technological dead-ends with Dr Aquilina mentioning a rechargeable pacemaker and a nuclear-powered one. Dr Aquilina explains that pacemakers work on lithium batteries, allowing them to last between six and eight years, which is good news for patients since they have to undergo surgery every time the pacemaker needs to be changed.
Today's pacemakers are also extremely small, but since they are implanted just under the skin on the upper chest, they still show in patients who are very thin. However, there have been a number of female patients who had their pacemaker implanted under the breast, where it does not show at all.
The history of pacing is interesting and indebted to many individuals who believed the impossible and set out to accomplish it. Pacemakers have developed from simple life-saving devices to tools that improve the quality of life, Dr Aquilina said.
Pacemaker patients personal stories
Name: James Camilleri
Age: 75
Date of first pacemaker: 1975
Thirty-three years ago, James Camilleri, then 42 years old, started fainting regularly.
"My pulse rate slowed down dramatically and I used to fall down on a regular basis. I would be walking normally and all of a sudden find myself on the ground as if someone had pushed me. But the moment I touched the ground, I would wake up again."
He was sent to a cardiologist who soon realised Mr Camilleri was in need of a pacemaker. "I did not even know what a pacemaker was," he said candidly.
Mr Camilleri was sent to London's St Mary Hospital to have the surgery, and admits he did not understand the English-speaking doctors all that well. "I barely knew what was happening."
His road to recovery came with some hiccups since a piece of equipment was missing. "I was sent back home and told that they would operate me again once a visiting professor came to Malta."
Mr Camilleri's life has changed drastically. "Before I could barely do anything that meant exerting myself. Even if I went walking, I would soon be out of breath. But after 15 days following the operation, I went swimming and have not looked back since.
I even used to take care of a piece of agricultural land." He has changed the pacemaker five times and today's model is much better than the first one he had implanted. "That one had batteries on the outside, which I used to have to change myself. It was pretty annoying. The modern ones are much more convenient."
Name: Joseph Sansone
Age: 59
Date of first pacemaker: 1980
When he was just 17 years old, Joseph Sansone had to be taken to the UK for open heart surgery to mend a hole in his heart. His life changed drastically, and from a sickly youngster, he started living a normal life.
Roll on a few years, and when he was in his early 30s he suffered a heart failure. "I was in the car after giving a lift to a friend. I did not feel anything, but my heart stopped and I crashed into the car in front of me.
"The moment they moved me I regained consciousness, and was rushed to hospital."
After a spate of tests, Mr Sansone was told he needed a pacemaker. "The moment I realised that I was going to be operated upon again, I fainted."
But once the pacemaker was put in place, his life went back to normal.
"My life did not change from before I had the pacemaker implanted, because I was only ill for a few hours. The biggest change was felt when I had surgery at 17 - before I used to get tired constantly, turn blue whenever I exert myself and feel extremely cold in winter."
Mr Sansone has had the pacemaker changed about five times. Does the scar annoy him? He admits that compared to the surgery scar, it is very small.
Name: Joe Borg (name changed)
Age: 30
Date of first pacemaker: 2005
When Joe Borg went to work one day in May 2005, nothing seemed out of the ordinary. But just a few hours later, he fainted while walking through the reception of the office building, losing consciousness for about a minute.
After six days in hospital, doctors detected a weak pulse and told him that he needed a pacemaker.
"At first I was stunned, but I have since learned to live my life with it. To be honest, it does not bug me at all."
He admits to never having felt that anything was amiss before the incident at work. "All was normal before, and all went back to normal after the surgery."
In fact, he admits to pushing himself to the limit, especially when working long hours, although he does not engage in contact sports and steers clear of body scanners.
"The doctors had suggested that I try not to exert myself, but shortly after surgery there was a big match between Liverpool and Milan, which ended in penalties. As an avid Liverpool supporter, I could not miss it, and did get quite a bit excited."
He said that although patients are sometimes worried about having a pacemaker implanted, they should not be because it allows them to have a better life. And it barely shows, he continued.