This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Efimov, I. R. Search for Related Content PubMed PubMed Citation Articles by Efimov, I. R. Related Collections Arrythmias-basic studies

(Circulation Research. 2000;87:429.)
© 2000 American Heart Association, Inc.

Editorials

A Shocking Experience

Ionic Modulation of Virtual Electrodes in Defibrillation

Igor R. Efimov

From the Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.

Correspondence to Igor R. Efimov, Elmer L. Lindseth Associate Professor of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-7207. E-mail ire@po.cwru.edu

Key Words: defibrillation • ionic channels • optical mapping

	Introduction

 
The discovery of defibrillation in 1899 by Prevost and Battelli¹ has left us one of the most exciting clinical and research puzzles of the 20th century despite the obvious success of this treatment for arrhythmias. Initially, the idea of arresting ventricular fibrillation by the application of electric shock had seemed too fantastic even for Wiggers et al,² whose research at Western Reserve University had laid the foundation for the first clinical application of defibrillation by Beck et al.³ During the last 2 decades of the 20th century, we witnessed clinical recognition and widespread application of implantable cardioverter-defibrillators (ICDs), which were stimulated in part by growing concern regarding the potentially harmful effects of antiarrhythmic drugs.⁴ Yet compelling evidence has been presented that pharmacological therapy combined with ICD therapy could decrease the frequency of shocks and improve the quality of life.⁵ Unfortunately, a lack of understanding of the ionic mechanisms of defibrillation impedes formulation of basic pharmacological strategies of defibrillation and redefinition of the role of antiarrhythmic drugs.⁴ The study by Cheek et al⁶ in this issue of Circulation Research presents one of the first attempts to build the basic science bridge between pharmacological and nonpharmacological therapies to control arrhythmias.

Many investigators during the 20th century were puzzled by the mechanisms of defibrillation. Unfortunately, the inability of existing techniques to record electrical activity of the heart during electric stimuli has hampered attempts to unravel these phenomena. A major breakthrough in the field occurred recently after the introduction of potentiometric optical probes. Using . . . [Full Text of this Article]