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(Circulation Research. 2003;92:1062.)
© 2003 American Heart Association, Inc.

Editorials

Fibrillation or Neurillation

Back to the Future in Our Concepts of Sudden Cardiac Death?

Igor R. Efimov

From 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@cwru.edu

Key Words: cardiac electrophysiology • ventricular fibrillation • neural repair • nerve sprouting • regeneration

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"If the heart trembles, has little power and sinks, the disease is advancing ... and death is near ... ." —The Papyrus Ebers (circa 3500 BCE)

Numerous concepts of cardiac electrophysiology have been advanced, enthroned, and then laid to rest. Other theories have withstood the test of time despite the restless energy of inquisitive doubt of future generations. Until recently, one such concept has been the foundation of the mechanisms of fibrillation, which was imprinted in the very name to emphasize its fibrillar or myogenic nature.

It was apparently known to ancient Egyptians and Chinese that an irregular heartbeat is associated with death. However, scientifically rigorous description of a causal relationship was presented only in the middle of the 19th century. Erichsen described in 1842 that coronary artery ligation led to "tumultuous," "tremulous," and "irregular" behavior of the ventricles.¹ First documentation of the onset of ventricular fibrillation (VF) during electrical stimulation was recorded in 1849 using Ludwig’s "kymographion" by his associate Hoffa.² Interestingly, at the time, Hoffa was assigned to investigate autonomic nervous system effects on cardiac activity, which had been discovered a year earlier by Ludwig himself.³ Hoffa described irregular contractions induced by "faradization" (electrical stimulation), which persisted even after the termination of electrical stimulation and resulted in cardiac arrest that could not be checked by vagal stimulation.

Intensive investigation of the newly described phenomenon led to the introduction of numerous terms, which aimed to capture the mechanistic and/or anatomic nature of the irregular contractions and resulting cardiac . . . [Full Text of this Article]