Clinical Cardiac Pacing and Defibrillation [antikvár]

Introduction: History of Cardiac Pacing Seymour Furman The history of heart bloclc and what has been called Stokes-Adams disease (syndrome) runs through the past 300 years of medical history. Initially, the syncopal episodes, which are part of the syndrome, were considered to be a category of epilepsy. "Epilepsy" associated with a slow pulse was first described at the beginning of the 18th century. Before Stokes described 7 cases, 11 other case descriptions had been made, 1 by Adams.' The earliest recorded description of what can now be regarded as bradycardia with syncope was by the Slovene Marko Gerbec (1658 to 1718) (in Latin, Marcus Gerbezius) who wrote, "I noticed something even more unusual about the pulse of two patients, one of whom, a melancholic, a hypochondriac, otherwise basically healthy, had such a slow pulse that the pulse of healthy person would beat three times before his pulse would beat for a second time; Otherwise the man had been robust, precise in his movements, but very sluggish, firequently dizzy, and from time to time subject to mild epileptic seizure."^ Further descriptions of slow pulse with syncope, all categorized as epilepsy variants, were provided by Morgagni in 1769: "He was in his sixty-eighth year, of a habit moderately fat, and of a florid complexion, when he was first seized with the epilepsy, which left behind it the greatest slowness of pulse, and in like manner a coldness of the body."' Other descriptions were made by Spens in 1793,'' by Burnett in 1824,= and the following by Adams in 1826,' "An officer in the revenue, aged 68 years, was just then recovering from the effects of an apoplectic attack----What most attracted my attention was, the irregularity of his breathing, and remarkable slowness of pulse, which generally ranged at the rate of 30 in a minute. . . . November 4, 1819, he was suddenly seized with an apoplectic attack, which in two hours carried him off " In 1846, WilUam Stokes' described seven cases, including case I—repeated pseudoapo-plectic attacks, not followed by paralysis: slow pulse, with valvular murmur. Stokes' further case descriptions associated syncope with slow cardiac rate and cardiac standstill as the cause of syncope. His reports were remarkably modem in perceptions and associations, which, because they had not been made by earlier workers, makes the first position of his name appropriate. In 1890, Huchard proposed the name Stokes-Adams disease, believing that Stokes' description was so far superior to Adams' or that of anyone else as to property be the first.® At that time, the term heart block had not yet been coined. Electrical stimulation by electric eels and the electric organ of the torpedo have been used therapeutically.'-Widespread electrical stimulation therapy during the 19th century was encouraged by individual cases of successful resuscitation and Volta's" invention of the battery to produce electricity, Galvani's'^ electrical stimulation of vertebrate muscle, Aldini," his nephew, of mammaUan muscular stimulation, and Bichat's" stimulation of the severed heads of guillotine victims. During the second half of the 19th century, research laboratory investigation of cardiac electrophysiology led to experimental mammalian" and human" cardiac stimulation and recommendations concerning routine therapeutic use of electrical stimulation." Gaskell" demonstrated in 1883 that atrioventricular con-ducdon in the tortoise was not a function of the nervous system but that the cardiac depolarization began in the atrium and spread across atrial tissue to the atrioventricular groove and then to the ventricle. By 1899, Wilhelm His Jr pubhshed an extensive analysis of a single patient with Stokes-Adams syndrome to demonstrate the independent contraction of atrium and ventricle, the ventricular bradycardia and asystole during the attack itself." In its title, the names of Adams-Stokes disease and the condition of heart block were linked. His had earlier identified the conduction bundle that bears his name and in 1895 had demonstrated that cutting it with a cataract knife produced atriovenuicular