Folia Cardiol. 2006, Vol. 13, No. 5, pp. 439–440 Copyright © 2006 Via Medica PEARLS AND GIANTS IN ISSN 1507–4145

“He that was dreaming… Saw his dream through” [Didi Manoussi, popular Israeli songwriter]

Michel Mirowski (1924–1990)

Frequently important innovations in diologist, he needs top overseas training. medicine, and not only just in medicine, are Upon receiving a fellowship, Michel ini- the consequence of circumstances. No one tially worked at the Instituto de Cardiolo- will belittle Alexander Fleming’s contribu- gica in Mexico City under Enrique Cabre- tion to the discovery of the miraculous ef- ra and Sodi-Pallares then he transferred fects of penicillin because his breakthrough to , Maryland as a fellow of observation was realized when he stum- Dr. Helen Taussig’s department. Only in bled upon mold falling from the roof of his 1963, after this extensive post-graduate laboratory which inhibited the growths of training, did he return to with his Staphylococcus aureus. On the other hand, wife and three children. other inventors carefully plan and diligently pursue In Israel Michel’s professional life was not wi- an idea or a concept and Michel Mirowski, whose life thout obstacles. His desire to work as a senior and achievements will be described here, belongs to member at the large and prestigious Tel Hashomer this category of geniuses. Michel had a dream and Hospital’s cardiology department, did not materia- he spent years of labor struggling to see it through. lize. Despite this set back he became a respected Mieczyslaw Friedman was born in 1924 in member of Tel Hashomer’s Department of Medi- Warsaw, to a Jewish family and his family cine and here started his life-long admiration of Prof. background and roots were admirably decribed by Harry Heller, Head of the Department. Later Mi- John Kastor [1]. The change of their name to Mi- chel became the Head and sole doctor of the Car- rowski came from the family’s wish to blend easily diology Unit at Assaf Harofe, a more peripheral into Polish society. In 1939, with the break out of government hospital. During these years my friend- WWII, Poland was in flames and 15 year old Mie- ship with Michel started when he embarked upon czyslaw fled eastward and survived the next five several research projects with the Cardiology De- years with false papers, hiding in small villages and partment’s experimental laboratory of my hospital forests while living in constant fear and danger. in Jerusalem, Hadassah. This cooperation resulted After the war, returning to Warsaw, Mieczyslaw did in lectures and publications on his then main rese- not find his father, brother or any other surviving arch interest, aberrant atrial rhythms [2]. relatives. Alone, he went to Gdansk and enrolled A tragic event changed Mirowski’s life and ca- at the University to study medicine but after one reer in 1966, his mentor Prof. Heller died suddenly year, in 1947, he immigrated to pre-State Israel. As after an episode of ventricular tachycardia termina- there was no medical school there at the time, he ting in ventricular fibrillation while at home with his traveled then to Lyon, France where he completed family. Michel realized that the life of Heller and his medical training. Here he adopted the name Mi- many other patients could be saved if at the time of chel, and upon marrying Anna, they returned to the VT/VF they were in a coronary care unit and Israel in 1954. Michel then started his residency in defibrillated there, or, if a defibrillator would be cardiology at the Tel Hashomer Hospital. He knew permanently available for them, probably implan- however, that in order to become a first rate car- ted into their body.

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This revolutionary concept of having a device Michel Mirowski’s achievements finally became ac- implanted permanently which can monitor and ana- cepted and highly regarded. lyze cardiac rhythm and deliver promptly a low We in Jerusalem felt fortunate that Michel energy shock to the heart whenever VT or VF oc- accepted my invitation to attend our International curs, became Michel Mirowski’s life’s obsession. Holter Symposium in March 1986. All of us enthu- When he felt that his hospital position and facilities siastically listened to his description of the “bum- in Israel were too restricted to develop his idea, he py road” in developing the ICD, as we watched with was ready to sacrifice his position and family secu- fascination the video of its dramatic use on the dog rity to pursue his dream in America. and admired his first hand account of the clinical Sinai Hospital in Baltimore offered Michel the success and follow-up of 900 patients. My invita- position of Head of the ICCU and there he found tion was only one of many for Michel Mirowski who a close friend and collaborator in Dr. Morton Mo- became an internationally sought after lecturer. wer, with whom the first steps were taken in ma- Now he really enjoyed the appreciation expressed terializing his concept. In the animal laboratory they by all cardiologists and scientists in the world and succeeded in implanting a defibrillator device in he saw how the device he envisioned is now saving a dog and when it collapsed due to an induced thousands of lives. VT/VF, the device automatically launched a shock Fate was not gracious with Michel Mirowski. to the heart, the animal immediately got up on its At the peak of his success, when he could see his feet and walked away. dream come through, Michel was diagnosed with In spite of the dramatic videotape which most multiple myeloma. At the time of my last personal convincingly documented that an implanted device meeting with him and Anna in Italy, Michel hinted can recognize and terminate a VT/VF event and the to me about his health problem. Michel Mirowski’s consequent publishing of his first report [3], the life was cut off in his prime as he died at the age of scientific world not only rebuffed this concept but 66, mourned by Anna, their three daughters, and even attacked Michel in an unusually harsh man- his friends and patients all over the world. ner. Lown and Axelrod [4] listed lengthily in a le- ading cardiology journal’s Editorial their technical References and ethical considerations, calling implanted stand- by defibrillators “an imperfect solution” and expres- 1. Kastor JA. Michel Mirowski and the implantable sed their view that “it was developed because it was cardiowerter defibrillator. In: Arrhytmias. 2nd Ed. possible”. W.B. Saunders Company, Philadelphia 2000; 2: 23–34. Michel was not only personally “bruised” by 2. Rogel S, Mirowski M. Experimetal left atrial rhythm. this editorial, as his daughter Ariella recalled [5], Isr J Med Sci, 1967; 3: 247. but the whole advancement of the project was slo- 3. Mirowski M, Mower M, Staewen WS, Tabatznik B, wed down by this vehement criticism. Only when Mendeloff AI. Standby automatic defibrillator: An ap- a new partner appeared on the scene, Dr. Stephen proach to prevention of sudden coronary death. Arch Heilman who was ready to invest the necessary Intern Med, 1970; 126: 158–161. funds for the continuation of the research, could the 4. Lown B, Axelrod P. Implanted standby defibrillators. project progress. In 1980 the first human implant Circulation, 1972; 46: 637–639. of a much more sophisticated device was success- 5. Mirowski M, Rosengard A. Introduction to Mirowski fully conducted, and thereafter published in a most Symposium. Ann Noninvasive Electrocardiol, 2005; prestigious medical journal [6]. From now on the 10: 3–5. success of the ICDs, the name by which the “Mi- 6. Mirowski M, Reid PR, Mower MM et al. Termina- rowski device” became known all over the world, tion of malignant ventricular with an never ceased. Between 1980–1985, more than 5,000 implanted automatic defibrillator in human beings. ICDs were implanted on both sides of the Atlantic. New Engl J Med, 1980; 303: 322–324.

Shlomo Stern, MD Emeritus Professor of Medicine 1 Shmuel Hanagid St. Mediclal Building, Room 201 Jerusalem 94592, Israel e-mail: [email protected]

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