Biography

Richard Langendorf, the distinguished electrocardiographer, clinical investigator, and one of the founders of "modern arrhythmology" died in Chicago on July 8,1987, He was one of the world’s leading scholars in cardiac arrhythmias and received the respect and admiration of his colleagues throughout the world.

Langendorf was born in Prague, Czechoslovakia and graduated from the German University of Prague in 1932. After graduation, Langendorf worked in the Department of Internal Medicine of Prague University (together with Alfred Pick) where he came under the strong and lasting influence of Max Winternitz who was, at the time a leading electrocardiographer and expert in the interpretation of cardiac arrhythmias. In 1939 Richard Langendorf managed to escape from Czechoslovakia and emigrated to the United States where he joined the Cardiology Department of Louis N. Katz at Michael Reese Hospital in Chicago and where he remained for the rest of his professional life.

In 1949 Langendorf was reunited with his life-long friend and associate, Alfred Pick, who had fortunately emerged from the trauma of Europe in the 1940s. Both continued to work together at the same institution for the rest of their lives As a result, for over 25 years until the advent of invasive electrophysiology in 1969, the Chicago school produced most of the major advances in the understanding of cardiac arrhythmias.

Pick and Langendorf (with Louis Katz) gave their famous advanced course on "Interpretation of Cardiac Arrhythmias" at Michael Reese Hospital for 26 consecutive years until 1980. Hundreds of physicians throughout the world sought to attend the yearly course and a number of participants have now become prominent electrocardiographers and electrophysiologists. The one-week course was also -exported" to Holland, Sweden, and France. As indicated by Fisch in PACE, Pick and Langendorf were honored simultaneously in 1975 by the American College of Cardiology by being given the prestigious Gifted Teacher Award. In 1979 Pick and Langendorf published their classic book Interpretation of Cardiac Arrhythmias representing a distillation of their vast experience in research and teaching. This book will remain an important landmark in the evolution of our knowledge and should be read and re-read by all serious students in the field.

It is now hard to imagine that before the introduction of invasive electrophysiology almost 20 years ago, arrhythmia research was restricted to the analysis of P waves and QRS complexes and their relationship to each other in the electrocardiogram. Thus, Langendorf's electrophysiology laboratory consisted of an electrocardiograph, ECG calipers, and the most important instrument in research, the mind of man. Equipped with sagacity and research acumen, Langendorf and Pick accurately postulated most of the important and now confirmed concepts of cardiac electrophysiology Their brilliant deductions and arm-chair speculations were based on careful studies of a large number of electrocardiograms coupled with their extensive knowledge of anatomy and physiology

Throughout his career, Richard Langendorf published many articles on electrocardiography and electrophysiology that have contributed substantially to our understanding of abnormal impulse generation and propagation in the heart. I believe that Richard Langendorf will probably be best remembered for his work on concealed conduction. While an impulse may not necessarily traverse a particular structure such as the AV node, it may, however, penetrate it partially so that a portion of the structure becomes depolarized and engenders a refractory period. The creation of this refractory barrier may be responsible for delay or block of subsequent impulses, the term "concealed" actually refers to the impulse that is not manifest on the surface ECG. The importance of concealed conduction as a key to understanding many arrhythmias was first emphasized by Langendorf in 1948 in his classic paper entitled Concealed AV Conduction: The Effect of Blocked Impulses on the Formation and Conduction of Subsequent Impulses in which the definition of the concept was clearly stated in the title. However, concealed conduction did not arouse much interest until 1956 when Katz and Pick in their famous book Clinical Electrocardiocardiography, Part I. The Arrhythmias further emphasized the mechanism by means of numerous illustrative electrocardiograms. Finally, in 1961, Hoffmann et al." provided the experimental proof of concealed conduction by direct recordings from specialized conducting tissue. This phenomenon is now widely accepted as taking place in any part of the conducting system. Another example of Langendorf's extraordinary powers of deductive reasoning is exemplified in his paper on "pseudo AV block" in which he correctly described the electrocardiographic manifestations of concealed extrasystoles in the His-Purkinje system. This phenomenon was subsequently confirmed with His bundle recordings by Rosen et al. in 1970.

Concealed conduction is now recognized as an extremely common phenomenon and as Fisch has pointed out, the understanding of the concept is a prerequisite for analysis of all but the most simple of cardiac arrhythmias. Credit for the concept of concealed conduction and its clinical significance must rightfully be attributed to Langendorf despite his claim, with characteristic humility, that the concept could actually be traced to the earlier work of Englemann and Erlanger.

I believe that Langendorf’s work will assume even far greater importance when put into proper historical perspective by future generations of scholars. Richard Langendorf was a giant and we all owe him a debt of gratitude.

- S. Serge Barold