Karel Wenckebach
Karel Frederik Wenckebach (1864-1940) was a Dutch physician.
Wenckebach is remembered as a pioneer in cardiac electrophysiology. Born in The Hague on 24 March 1864, he studied medicine at the University of Utrecht from 1881, graduating in 1888 with a thesis on the bursa of Fabricius. Initially intent on a career in zoology, Wenckebach’s colour blindness forced a redirection toward physiology, where he trained under Theodor Wilhelm Engelmann (1843–1909), gaining expertise in kymographic methods and rhythm disturbances in experimental animals.
In 1891, Wenckebach entered rural general practice in Heerlen, where he began correlating clinical pulse irregularities with the patterns he had seen in Engelmann’s frog experiments. In 1899 he published his landmark description of Wenckebach periodicity (Mobitz type I AV block). Drawing on meticulous analysis of arterial pulse tracings from a woman with an irregular heartbeat, he postulated a conduction abnormality rather than extrasystole. Wenckebach’s careful observation predated both electrocardiography and the anatomical discovery of the AV node.
His subsequent academic appointments included chairs of medicine at the universities of Groningen (1901), Strasbourg (1911–1914), and Vienna (1914–1929). At Vienna, he remained a central figure in cardiology, especially during and after the First World War. His influential texts—such as Arrhythmia of the Heart (1904) and the later Die unregelmäßige Herztätigkeit, cemented his reputation. Wenckebach also investigated quinine’s effects on arrhythmias and contributed to the understanding of circulatory failure and beriberi.
A revered teacher and clinical scientist, Wenckebach received numerous honours and remained active internationally. He delivered prestigious lectures, including the St. Cyres and Gibson Memorial Lectures, and participated in relief missions and scholarly commemorations. He died on November 11, 1940 in Vienna, leaving a legacy as one of the founding figures of modern cardiology.
Biography
- 1864 – Born March 24 in Den Haag, Netherlands.
- 1881–1888 Studied medicine at the University of Utrecht under Donders and Engelmann.
- 1888 – Graduated Doctor of Medicine with thesis on the bursa of Fabricius.
- 1888–1891 – Worked at the zoological institute and in pathology/anatomy; redirected to physiology due to colour blindness.
- 1891 – Entered rural general practice in Heerlen; began clinical observation of pulse irregularities.
- 1892 – Married while in practice in Heerlen.
- 1896 – Returned to Utrecht; resumed laboratory work under Engelmann’s successor, H. Zwaardemaker.
- 1898 – Observed and analysed pulse irregularity in a 40-year-old woman; recognised phenomenon later termed Wenckebach periodicity (Mobitz I AV block).
- 1899 – Published “Zur Analyse des unregelmässigen Pulses” describing group beating and Luciani periods.
- 1901 – Appointed Chair of Medicine at University of Groningen.
- 1904 – Published Arrythmia of the Heart .
- 1911–1914 Chair of Medicine at University of Strasbourg.
- 1914–1929 Chair of Medicine at University of Vienna; focused on cardiac pathology in soldiers and beriberi.
- 1919 – Initiated medical relief mission to Vienna following World War I.
- 1929 – Retired from Vienna chair; delivered oration at Birmingham General Hospital sesquicentennial.
- 1930 – Awarded honorary LL.D. by University of Edinburgh.
- 1934 – Published important monograph on beriberi
- 1940 – Died November 11 in Vienna, aged 76.
Medical Eponyms
Mobitz type I (Wenckebach block)
- Progressive prolongation of the PR interval culminating in a non-conducted P wave
- PR interval is longest immediately before the dropped beat
- PR interval is shortest immediately after the dropped beat
Second-degree Atrioventricular block: Mobitz Classification
- Mobitz type I (Wenckebach)
- Mobitz type II (Hay)
In 1898 Karel Wenckebach consulted a 40-year-old woman with an irregular pulse which he interrogated using a sphygmogram and tuning fork. He noted there were regular pauses every 3 to 4 beats, but the small extra pulse seen during pauses were longer, and subsequent intervals were smaller. The first interval after each pause was longer, and subsequent intervals were shorter.
Wenckebach credited Luigi Luciani (1840-1919) as the first to describe this recurrent pattern in his 1873 frog heart experiments and defined this form of group beating as ‘Luciani’schen Perioden‘ (Luciani periods)
Original
English
Man spricht in diesen Fällen von einer “periodischen Function” des Herzens; die Gruppen werden nach dem Entdecker “Luciani’sche Perioden” genannt.…es sich hier um eine regelmässige Herzthätigkeit handelt, welche von einem constantcn schädlichen Einfluss gestört wird. Dieser Einfluss ist ein negativ dromotroper Einfluss, wie aus einer sorgfältigen Vergleichung dieses Pulses mit der Ventrikelthätigkeit des in Luciani’schen Perioden klopfenden Froschherzens hervorgeht.
In these cases one speaks of a “periodic function” of the heart; the groups are called “Luciani periods” after the discoverer… it is a regular cardiac activity, which is disturbed by a constant harmful influence. This influence is a negative dromotropic influence, as can be seen from a careful comparison of this pulse with the ventricular activity of the frog heart pounding in Luciani’s periods.
Wenckebach’s figure demonstrates a constant atrial rate (top line) with diagonal lines (representing AV conduction) progressively lengthening before a beat being missed/dropped. This is followed by the recommencement of the cycle.
With the advent of electrocardiography in the early 20th century, this form of group beating became known as ‘Wenckebach periodicity‘ and later as ‘Mobitz type I atrioventricular block‘.
Other eponyms
- Wenckebach phenomenon – the eponymous block, demonstrated after the advent of Einthoven’s string galvanometer electrocardiograph
- Wenckebach sign – paradoxical movements of the chest in chronic mediastinopericarditis
- Wenckebach bundle – a band of muscle passing from the SVC to the right atrium
- Wenckebach heart – small heart positioned in the midline of the thorax (mesocardia)
- Wenckebach Pills – quinine tablets which he showed could halt paroxysm of atrial fibrillation
Key Medical Contributions
Pre-electrocardiographic Pioneering – Wenckebach made landmark discoveries in cardiac rhythm before the advent of the electrocardiogram and prior to the anatomical identification of the sinoatrial and atrioventricular nodes. His work was based on kymographic methods and mechanical pulse tracings, highlighting extraordinary clinical and physiological insight. First reported ventricular extrasystoles with compensatory pauses in humans and demonstrated that atrial extrasystoles were not accompanied by a compensatory pause
Monographs and Texts – His 1904 publication Arrhythmia of the Heart and the later comprehensive text Die unregelmäßige Herztätigkeit (with Winterberg) helped define functional arrhythmias as disturbances of myocardial properties, establishing a modern physiological understanding of cardiac conduction disorders.
Broader Contributions – Wenckebach was among the first to describe the effects of quinine alkaloids on arrhythmias (successfully used quinine to treat paroxysmal atrial fibrillation), investigated beriberi heart disease, and made early contributions to chest radiography and artificial pneumothorax
I owe my reputation to the fact that I use digitalis in doses the text books say are dangerous and in cases that the text book say are unsuitable
Quoted BMA meeting July 21st 1937
Major Publications
- Wenckebach KF. Zur Analyse des unregelmässigen Pulses. I. Zeitschrift Für Klinische Medizin. 1899; 36: 181-199
- Wenckebach KF. Zur Analyse des unregelmässigen Pulses. II. Ueber den regelmässig intermittirenden puls. Zeitschrift Für Klinische Medizin. 1899; 37: 475–488
- Wenckebach KF. Zur Analyse des unregelmässigen Pulses. III. Ueber einige Formen von Allorhythmie und Bradykardie. Zeitschrift Für Klinische Medizin. 1900; 39: 293-305
- Wenckebach KF. Zur Analyse des unregelmässigen Pulses. IV. Ueber den Pulsus Alternans. Zeitschrift Für Klinische Medizin. 1902: 44: 218-225
- Wenckebach KF. De Analyse van den onregelmatigen Pols I. Nederlands Tijdschrift voor Geneeskunde. 1898; 42: 297-316
- Wenckebach KF. De Analyse van den onregelmatigen Pols. II. Over den regelmatig intermitteerenden Pols. Nederlands Tijdschrift voor Geneeskunde 1899; 43: 665-79
- Wenckebach KF. De Analyse van den onregelmatigen Pols. IV. Over den Pulsus Alternans. Nederlands Tijdschrift voor Geneeskunde 1901; 45: 75-81
- Wenckebach KF. Die Arhythmie als Ausdruck bestimmter Funktionsstörungen des Herzens. 1904.
- Wenckebach KF. Arhythmia of the heart: a physiological and clinical study. 1904 [Translation Thos. Snowball]
- Wenckebach KF. Beiträge zur Kenntnis der menschlichen Herztätigkeit [Contributions to the knowledge of human cardiac activity]. Archiv für Anatomie und Physiologie. I 1906:297–354. II 1907:1-24
- Wenckebach KF. Die unregelmässige Herztätigkeit und ihre klinische Bedeutung. 1914
- Wenckebach KF. Über Reizleitung und Reizleitungsstörung im Herzen. Deutsches Archiv für klinische Medizin. 1918;125:222-227.
- Wenckebach KF. Cinchone derivatives in the treatment of heart disorder. JAMA. 1923; 81(6): 472-474
- Wenckebach KF. Angina Pectoris and the Possibilities of its Surgical Relief. Brit med J 1924;1:809
- Wenckebach KF. Die unregelmässige Herztätigkeit. 1927
- Wenckebach KF. Toter Punkt “SecondWind” und Angina Pectoris. Wiener klinische Wochenschrift. 1928;41:1.
- Wenckebach KF. St. Cyres Lecture: Heart and Circulation in a Tropical Avitaminosis (Beri-beri). Lancet 1928;2(5476):265-268
- Wenckebach KF. An Oration on THE USE OF FOXGLOVE AT THE BEDSIDE. Br Med J. 1930 Feb 1;1(3604):181-4.
- Wenckebach KF. Herz und Kreislaufinsuffizienz [Cardiovascular insufficiency] 1931.
- Wenckebach KF. Das Beriberi-Herz: Morphologie, Klinik, Pathogenese. 1934
References
Biography
- Fye WB. Karel Frederik Wenckebach, 1864-1940. Clin Cardiol. 1990; 13(2): 146-148.
- Cooper J, Marriott HJ. To Wenckebach: a centenary salute. Tex Heart Inst J. 1999; 26(1): 8–11.
- Lüderitz B. Karel Frederik Wenckebach (1868-1940). J Interv Card Electrophysiol. 2003 Feb;8(1):77.
Eponymous term references
- Wenckebach on Digitalis. In: BMA Meeting July 1937. Lancet; 230(5950): 633
- Mendoza-Davila N, Varon J. Resuscitation great. Karel Wenckebach: the story behind the block. Resuscitation. 2008; 79(2): 189-92.
- Upshaw CB Jr, Silverman ME. The Wenckebach phenomenon: a salute and comment on the centennial of its original description. Ann Intern Med. 1999 Jan 5;130(1):58-63.
- Silverman ME, Upshaw CB Jr, Lange HW. Woldemar Mobitz and His 1924 Classification of Second-Degree Atrioventricular Block. Circulation. 2004 Aug 31;110(9):1162-7.
- Tandon A, Simpson L, Assar MD. Unusual origin of type 1 atrioventricular block with comments on Wenckebach’s contribution. Proc (Bayl Univ Med Cent). 2011; 24(1): 9–12
- Cadogan M. History of the Electrocardiogram. LITFL
- Cadogan M. History of Second-degree Atrioventricular block. LITFL
Eponym
the person behind the name
