Cardiology · 1958
First implantation of a permanent cardiac pacemaker (Senning and Elmqvist)
Before October 1958, a patient with complete heart block had two options: an external pacing unit that required electrodes passing through the chest wall, tethering the patient to a machine the size of a suitcase, or no treatment at all. Arne Larsson was 43 years old, suffering multiple syncopal episodes each day from complete atrioventricular block, and his wife Elsa had contacted every researcher she could find. She reached Rune Elmqvist, a Swedish engineer and physician working at Elema-Schonander, who had been quietly developing a transistorized pacemaker small enough to implant.
Ake Senning, a cardiac surgeon at Karolinska Hospital in Stockholm, performed the implantation on October 8, 1958. The device Elmqvist had constructed was roughly the size of a hockey puck, powered by rechargeable nickel-cadmium batteries, and encased in epoxy resin. Senning placed it under the skin of the chest wall with epicardial leads sutured directly to the myocardium, a procedure requiring full thoracotomy. The first unit failed within hours of implantation; Senning operated again the following day, placing a second device that lasted approximately a week before Larsson's own spontaneous rhythm partially recovered.
Larsson's recovery was incomplete, and he required pacing for the rest of his life. Over the following decades he received at least 26 successive devices as technology advanced, each smaller and more reliable than its predecessor. He lived until 2001, dying at age 86, having outlived both Senning and Elmqvist. His longevity became the clearest possible demonstration that chronic implanted pacing was compatible with a normal lifespan.
The surgical approach changed dramatically within a few years. William Chardack and Andrew Gage in Buffalo developed a more reliable implantable design, and Seymour Furman in New York demonstrated transvenous endocardial pacing in the early 1960s, threading electrodes through the subclavian vein to the right ventricle and eliminating the need for thoracotomy. This made pacemaker implantation a procedure cardiologists could perform under local anesthesia, and it spread rapidly through the decade.
By the late 1960s, permanent pacemakers were in widespread clinical use for sick sinus syndrome and advanced heart block. Later iterations added demand pacing that fired only when the intrinsic rate fell below a threshold, then dual-chamber sensing and rate-responsive algorithms that adjusted output to activity level, and finally remote telemetry allowing device interrogation without a clinic visit. The October 1958 implantation at Karolinska established the basic proposition on which all of those advances rest: that a battery-powered device inside the chest can safely and durably take over the heart's timing function.
Key People
- Ake Senning — Cardiac surgeon who implanted the device at Karolinska Hospital.
- Rune Elmqvist — Engineer and physician who designed the transistorized pacemaker.
- Arne Larsson — First recipient of a permanent implanted pacemaker; lived 43 years with devices.
- Seymour Furman — Developed transvenous pacing, eliminating the need for open-chest implantation.
Netherlands Heart Journal, 2008 (historical review)
Related landmarks
- 1961 · Factors of Risk in the Development of Coronary Heart Disease (Framingham Heart Study) (Cardiology)
- 1954 · Warfarin introduced for clinical anticoagulation (Cardiology)
- 1953 · First Successful Open-Heart Surgery Using the Heart-Lung Machine (Cardiology)
- 1980 · Implantable cardioverter-defibrillator first human implantation (Mirowski) (Cardiology)