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 Etienne 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

Galina Kichigina, Ph.D.

Institute for the History and Philosophy of Science and Technology, University of Toronto, 91 Charles St W Toronto, Ont, Canada M5S 1K7, [email protected]

Jose Jalife, M.D.

Center for Arrhythmia Research, University of Michigan, 5025 Venture Drive, Ann Arbor, MI 41808, USA, [email protected]

I. R. Efimov et al. (eds.), Cardiac Bioelectric Therapy: Mechanisms and Practical Implications. © Springer Science+Business Media, LLC 2009

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.

Extensive studies to explain the mechanism of fibrillation centered around two competing theories: circus movement reentry and so-called tachysystole from a single focus. Electro-physiological investigations with the use of increasingly sophisticated technologies done in the late 1940s dismissed the circular movement hypothesis, which had been dominant for nearly 30 years, later used as an explanatory model in more elaborated and sophisticated form. Yet, the intellectual vitality of the basic concepts of the nineteenth- and early twentieth-century cardiovascular physiology for understanding ventricular fibrillation would always ensure interest and fascination of modern researchers.

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