Ventricular Fibrillation: A Historical Perspective

This chapter explores some scientific and technological aspects of the emergence of modern cardiology in the late nineteenth century that were important to the formation of cardiac electrophysiology, which rose into prominence in the 1940s–1950s. The chapter features the historical growth of ideas, concepts and understanding of ventricular fibrillation (VF) as a distinct clinical condition among the disturbances of the heart's rhythm.

To describe the ideas, concepts, and technical methods that led to modern understanding of VF, we shall touch on some of the important developments in cardiovascular physiology and instrumentation, which were to reshape the clinical conception of cardiac arrhythmias. Much of this work took place in continental Europe, most notably in the laboratories of Carl Ludwig in Leipzig and of Étienne Jules Marey in Paris. At the end of the nineteenth century much of the physiological research that became essential to modern conceptions of arrhythmias concentrated on the problem of the heart's rhythmic activity. There also appeared a number of anatomical and histological studies crucial for the deeper understanding of the specialized cardiac conduction system. The fundamental physiological concepts of the heart action were also paralleled by transformations in clinical medicine. Clinicians began to focus their attention specifically on heart rhythm disorders, drawing extensively on physiological work on rhythmicity and using instruments adapted or devised for this particular purpose. A watershed event occurred in the early twentieth century, when a new and promising approach for recording the heart's action through its electrical activity was set forth by Willem Einthoven in Leiden and Thomas Lewis in London. It was during these years that most of the cardiac arrhythmias were described, the electrocardiographic basis of atrial fibrillation (AF) was established, and AF and VF were clearly distinguished.