34. A brief history of cardiac arrhythmia

Throughout the ages there has been little else as impressive to both the patient and physician as abnormalities and aberrancy in the heartbeat. It was through careful observation and characterization of physiology that the tactile measurement of the pulse translated and evolved in to the vast field of cardiology we know today. For thousands of years the only window physicians had into the hearts of their patients was through palpation of a pulse. The ancient Egyptians, Chinese and Greeks are credited with measurement and characterization of peripheral pulses and their association with illness. The work of Claudius Galen (129-199) furthered the association of pulse to cardiac function. Galen’s work set the stage for William Harvey’s (1578-1657) first description of the circulatory system and thereafter the function of the heart. However, it was not until the advent of electrocardiography that modern, efficient studies of cardiac rhythm began. The work of August Desir Waller (1856-1922) and Willem Einthoven (1860-1927) revolutionized the study of arrhythmia with the advent of the electrocardiogram (ECG). This instrument transformed the diagnosis of heart disease and catalyzed the creation of cardiology as a subspecialty. It was through the use of the ECG that cardiac rhythm disorders were first characterized. James Mackenzie and Arthur Cushny first recognized atrial fibrillation and the work of Drs. Wolf, Parkinson and White theorized the neuro-cardiac function of the heart. Further study led to the discovery of the Purkinje system and the mechanics of cardiac electrical conduction. Medicine has thus used many approaches in the treatment of arrhythmias, employing pharmacology, electricity and surgery, with an ever-evolving spectrum of treatment. It was through observation, innovation and determination that diseases of the heart are understood and treated today. Hanon S, Shapiro M, Schweitzer P. A troubled beginning: Evolving concepts of an old arrhythmia. J. Electrocardiol. 2005 (July); 38(3):213-7. Fye,W. Tracing atrial fibrillation - 100 years. N Engl J Med. 2006 (Oct); 5;355(14):1412-4. Lüderitz B. History of the disorders of cardiac rhythm. 3rd Ed. Armonk, NY: Futura Pub. Co., 2002