The military heart hospitals

This is the first in a series of four papers that Dr. Wooley wrote exclusively for The American Heart Hospital Journal based on his book, The Irritable Heart of Soldiers and the Origins of Anglo-American Cardiology, published by Ashgate Publishing in 2002.1 Dr. Wooley's book also casts light on the origins of the specialty heart hospital.

History of cardiac rhythm disorders

The history of cardiac rhythm disorders including antiarrhythmic drugs and electrotherapeutical tools is long and fascinating. In the beginning, there was not simply the anatomy and physiology of the heart, but also analysis of the pulse, which indicates the activity of the heart. Thus, like any other field of medicine, the study of arrhythmias has a distinctive past. Our current level of knowledge is not the result of a straight, linear progression any more than there is a static, established, monolithic body of thought dominating this field. Instead, our knowledge of arrhythmias today is the result of many competitive, sometimes serendipitous, scientific realizations, of which a few proved useful enough to pursue and eventually led to real advancements. Looking at the worldwide development of rhythmology it can be said that considerable contributions came from Germany in the last few centuries. Arrhythmology--past, present and future--includes clearly German investigators as pioneers of the field. The growing clinical importance of electric cardiac stimulation has been recognized and renewed as Zoll in 1952 described a successful resuscitation in cardiac standstill by external stimulation. The concept of a fully automatic implantable cardioverter-defibrillator system for recognition and treatment of ventricular flutter/fibrillation was first suggested in 1970. The first implantation of the device in a human being was performed in February 1980. By early 1997, 17 years after the first human implantation more than 100,000 ICD systems had been implanted worldwide. Further developments concern new pharmacological compounds, modern cardioverter-defibrillators, radiofrequency ablation, particularly pulmonary vein ablation in atrial fibrillation, innovative pacemakers including preventive pacing techniques, probably laser therapy and perhaps the automatic implantable pharmacological defibrillator. The advances in the field of therapeutic application of pharmacologic and electrical means as well as alternative methods will continue as rapidly as before in order to give us further significant aid in taking care of the patient.

The Chicago School of Arrhythmology: revisited

The Chicago School of Arrhythmology (Katz, Langendorf and Pick) dominated the field of arrhythmias for at least 20 years until the advent of intracardiac electrophysiology in the late sixties. Thereafter they still played a fundamental role. Whereas other arrhythmologists also made contributions, they did not develop "schools" in the classical Platonic sense. The Chicago School's intuitive, deductive and inductive contributions to the understanding of multiple electrophysiological mechanisms were well appreciated, recognized and corroborated by basic and clinical electrophysiologists. Less known was their ability to propagate this knowledge in semi-tutorial courses which were so unique in explaining complex arrhythmic concepts that it is still used today by those who inherited their prominent position in the ever expanding world of invasive electrophysiology.

[100 years' of ECG or 100 years' of excellence in recording the electrical activity of the human heart]

The authors present a brief history of high-standard records of the electric activity of the human heart. Its beginnings date back to 1892 when Willem Einthoven recorded the first electrocardiogram.

[History of development of manufacture of implanted pacemakers: plans and reality]

The paper deals with the history of design and development of implanted pacemakers, emphasis is also laid on electric neuromyostimulators. Present-day problems and prospects in this area are touched upon.

We have come a long way with device therapy: historical perspectives on antiarrhythmic electrotherapy

The history of device therapies is long and fascinating. In the beginning, there is not simply the anatomy and physiology of the heart, but also analysis of the pulse, which indicates the activity of the heart. The analysis of the (peripheral) pulse as a mechanical expression of heart activity goes back several millennia. In China, in 280 BC, Wang Shu He wrote 10 books about the pulse. The Greeks called the pulse "sphygmos"; thus, sphygmology deals with a theory of this natural occurrence. In Roman times, Galen interpreted the various types of pulse according to the widespread presumption of the time that each organ in every disease has its own form of pulse. The growing clinical importance of electrical cardiac stimulation was recognized and renewed as Zoll in 1952 described a successful resuscitation in cardiac standstill by external stimulation. Meanwhile, millions of patients with cardiac arrhythmias worldwide have been treated with pacemakers in the last 40 years. The concept of a fully automatic implantable cardioverter defibrillator system for recognition and treatment of ventricular tachyarrhythmias was first suggested in 1970. The first implantation of the device in a human being was performed in February 1980. Further developments involved atrial and atrioventricular defibrillators, radiofrequency ablation, laser therapy, and advanced antiarrhythmic surgery. Since 1990, there has been a growing interest in using cardiac pacing as additional treatment in severe cardiac failure. Recent reports have suggested that intervention with left ventricular or biventricular pacing may be helpful for a subgroup of patients with congestive heart failure. Despite encouraging (preliminary) acute and short-term results, pacing strategies for heart failure still are limited and currently regarded as investigational. Advances in the field of therapeutic application of pharmacologic and electrical tools as well as alternative methods will continue as rapidly as before and provide us further significant aid in taking care of patients.

The evolution of internal defibrillators

ICDs have reduced mortality from SCD to 2% per year, which is a record unmatched by any other form of therapy. With continued evolution, ICD systems should become easier to implant, smaller, more effective in managing a variety of abnormal rhythms, and more comfortable for the patient. Implementation of technological innovations in future-generation devices should continue to extend the frontiers as clinicians consider ICDs for an expanding range of therapeutic applications.

Pacing and ICD therapy in Germany (West and East) before and after reunification in 1989

In 1989 the two German countries, FRG and GDR, were reunited after 50 years of political separation. During this time, these countries underwent independent, and in parts quite different, developments. While the reunification has had less effect on the overall situation in the Western part of the country, the Eastern part has experienced considerable changes, including the health service. In the field of pacing and ICD therapy, this study finds that 8 years after the reunification, the German federal states of both parts of the country have converged in the field of pacing and ICD therapy.

Evolution and revolution in drug labeling: regulation of antiarrhythmic drugs by the Food and Drug Administration 1962-1996

Between 1962, when the Kefauver-Harris Drug Amendments were passed, and 1996, 20 pharmaceutical compounds were approved and labeled by the FDA as effective antiarrhythmic drugs for some specified cardiac arrhythmia. Drug research and development in the 1970s and 1980s were focused on treatment of premature ventricular beats as a marker for sudden cardiac death and ventricular tachycardia. The Cardiac Arrhythmia Suppression Trial in 1989 irrevocably altered this approach. Recent drug development programs have targeted atrial fibrillation (AF) as epidemiologic data have predicted an increase in the incidence of AF as the United States population ages, and as treating premature ventricular beats has fallen from favor. The FDA, the scientific community, and the pharmaceutical industry have all participated in and been affected by this evolution in drug development.