Lessons from the first patient with an implanted pacemaker: 1958-2001.

On October 8, 1958 the world’s first pacemaker implantation was performed at the Karolinska Hospital in Stockholm, Sweden. The system had been developed by the surgeon A ◦ ke Senning and the physician inventor Rune Elmqvist. The patient was a 43-year-old engineer suffering from Stokes-Adams syndrome. His name was Arne H.W. Larsson (Fig. 1). At the time Senning was in charge of the experimental laboratory at the newly inaugurated Department of Thoracic Surgery at the Karolinska Hospital in Stockholm. Elmqvist was head of the Electromedical Division at Elema Schönander in Stockholm. He had studied medicine in Lund, Sweden but had not pursued a medical practice. Rather, he had become a self-taught engineer. In 1931 he had designed the first portable optical electrocardiographic (ECG) recorder and in 1948 had introduced the well-known direct writing Mingograf ink jet recorders. When Senning and Elmqvist met in 1950 they began a close cooperation in the development and testing of fibrillators and defibrillators for use in conjunction with open heart surgery, then an experimental procedure. Senning had studied and been inspired by the experimental work of Bigelow and Callaghan1,2 in stimulation for hypothermic cardiac standstill and Zoll who used external chest wall stimulation for management of Stokes-Adams attacks.3,4 During a visit to Minneapolis in 1957, Senning observed C. Walton Lillehei during open heart surgery suture stainless steel electrodes to the ventricle to manage surgically caused atrioventricular (AV) block, after closure of a ventricular septal defect. The wires were led through the thoracic wall and connected to an external pulse generator. This method avoided the discomfort and placement problems in the postoperative patient associated with Zoll’s external pacemaker. Senning considered this to be the beginning of the era of clinical pacing.5,6 On returning to Stockholm, Senning studied Lillehei’s technique experimentally and clini-