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The First Pacemaker Implant in America

In January, 1986, as part of the First InterAmerican Cardiac Pacing Symposium I had the honor of describing my experience with the first totally implantable pacemaker in America, which was the second pacemaker implanted anywhere in the world. During my internship and later while working in the hospital emergency department I had often been frustrated by my inability to effectively treat patients with Adams-Stokes seizures. At a time when even external cardiac massage was unknown the only therapeutic option was intravenous or intracardiac administration of drugs such as atropine, epinephrine or sodium lactate. In most instances treatment was unsuccessful or the side effects of the large doses of medication required, were not tolerated. My interest in cardiac pacing began with reading of Zoll's 1952 initial description of transthoracic cardiac stimulation. The possibility of electrical cardiac stimulation was very encouraging as an emergency treatment for patients with Adams-Stokes seizures. Still, we had the residual problem of management of those who, once resuscitated, persisted with atrioventricular block and experienced repeated episodes of cardiac arrest. In 1954, Professor Clarence Crafoord invited me to train in cardiac catheterization and angiography at the Karolinska Institute in Stockholm. I worked in the department of cardiology of the pediatric clinic under the direction of Professor Bjorn Wallgren. At that time a very close working relationship existed between that department and Elema-Schonander, a Swedish manufacturer which tested much of its medical equipment at the clinic. I had the privilege of meeting Dr. Rune Elmqvist, a friendly and innovative engineer, who was the director of the Department of Electronics at Elema-Schonander, and joining him in discussing the feasibility of developing an im-