This section contains in-depth information on topics specifically related to the history of pacing, electrophysiology and cardioversion-defibrillation. It is hoped that each of the segments will provide an interesting and informative look at subjects of interest.
Interviews & Presentations
- History of Cardiac Electrophysiology (Heart Rhythm 2010 session)
- Visit the HeartRhythm Journal website for Rhythms in History Podcasts as Editor-in-Chief Douglas P. Zipes, MD, FHRS talks with the men and women who have shaped electrophysiology.
Films
- An Atraumatic Technique for Inserting Double Sets of Electrodes
New technique for lead placement for dual chamber pacing. (1980) — Learn more »
- Tony's Cardiac Pacemaker
The Science Report: Tony's Cardiac Pacemaker, from United Press Movietone (circa 1957). Tony is tethered by a 20-foot electrical cord to an external pacemaker; there is a depiction of how the machine, operated by his wife, saves him when his heart stops. Tony states that the machine has saved his life six times. — View now (5:05) »
- Interview with First Patients to be Successfully Defibrillated, featuring Claude S. Beck, MD
Death can be reversed after heart fibrillation; first successful defibrillations in medical history. (1958) — Learn more »
- Historic Film circa 1952 of Clinical Pacing with Closed Chest Technique
First use of electrodes for external closed chest technique for cardiac stimulation to pace the heart. (1952) — Learn more »
- Emergency Transvenous Cardiac Pacing
Detailed technique for emergency tranvenous pacing. (1974) — Learn more »
- Implanted Pacemakers: Long Term Follow-Up
Procedures for patient follow-up with the introduction of telephonic monitoring. (1974) — Learn more »
Slideshows
- The ECG Alphabet: The Waves of the Electrocardiogram
Discovery and naming of the electronic signals of the heart. (2001) — Learn more »
- The Evolution of Clinical Electrophysiology in the Past 20 Years: Two Decades of Insights into the Mechanisms and Treatments of Superventricular Arrythmias
With the discovery of the ability to controllably stimulate a cardiac accessory pathway and other subsequent innovations, the discipline of clinical cardiac electrophysiology was born — Learn more »
- Special Notation for Paced-ECG Analysis
Three techniques for "modeling" the interaction between an antibradycardia pacemaker and the cardiac conduction system as told by Dr. Alan Bernstein. (2002) — Learn more »
Webpages
- Hyman's Pacemaker — more
- Pacemaker, Defibrillator, and Lead Codes — more
- Centro de Construccion de Cardioestimuladores del Uruguay: Origins and Objectives — more
- World Symposia of Cardiac Pacing and Electrophysiology — more
The Work of Pioneers
- The Work of Barouh V. Berkovits — more
- The Work of Howard B. Burchell, MD — more
- The Work of Paul M. Zoll, MD — more
- The Work of Augustus Desiré Waller — more
- Posters, one honoring the first clinical electrophysiology laboratory in the United States, focused on the work of Anthony N. Damato, MD and the renowned group of cardiac fellows he trained, the other honoring Brian F. Hoffman, MD, admired for his intellectual grasp of the entire field from biophysical studies of basic mechanisms through clinical studies of arrhythmias — more
An Atraumatic Technique for Inserting Double Sets of Electrodes
Produced and narrated by Victor Parsonnet, MD 1980
This film was made at a time when subclavian puncture had recently been introduced for placement of leads into the venous system and a shift was underway from single chamber ventricle pacing to dual chamber pacing. A technique was required to insert atrial and ventricular leads into the subclavian vein when both cannot fit readily through a single cannula. A technique was required to place two cannulae into the subclavian vein and it is demonstrated in this film. Such techniques facilitated the then new use of dual chamber pacing.
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(Running time: 14:11)
Note: You will need to have the free Windows Media Player to view the film.
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Tony's Cardiac Pacemaker
The Science Report: Tony's Cardiac Pacemaker, from United Press Movietone (circa 1957). Tony is tethered by a 20-foot electrical cord to an external pacemaker; there is a depiction of how the machine, operated by his wife, saves him when his heart stops. In the film Tony states that the machine has saved his life six times. —View now (5:05) »
Interview with First Patients to be Successfully Defibrillated, featuring Claude S. Beck, MD
See also:
This segment from the circa 1958 film, "Life and Death Relationships: The Heart and Its Blood Supply", features cardiac pioneer Claude S. Beck, MD interviewing a group of patients who were among the first to have their fibrillating hearts treated by defibrillation. Included in this segment is the patient (Richard H.) who was the first in medical history (1947) to have his heart successfully defibrillated at the age of 14 by Dr. Beck.
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(Running time: 4:00)
The film was provided by the Dittrick Medical History Center of Case Western Reserve University.
Note: You will need to have the free Windows Media Player to view the film.
From the narration of the film: "'This is the 'Choir of the Dead.' Death was reversed in these victims by prompt resuscitative measures which included mouth to mouth respiration, bag respiration, cardiac massage and, in some cases, defibrillation. They are alive years later with the same heart. Morbid disease remained the same. It was not cured. The hearts of these patients had mileage left in them. They needed a second chance to beat. The death factor is mobile. It can be moved around. It can be delayed or prevented in a good heart. It can be brought on in a good heart. It can be erased as though it never occurred."
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Historic Film (circa 1952) of Clinical Pacing with Closed Chest Technique
On August 28, 1952, Paul M. Zoll paced the first patient ever with the external closed chest technique which he developed. While cardiac stimulation occurred, this patient did not survive to leave the hospital. One month later, he paced patient number two who did leave the hospital, though his longer survival was never recorded. In both of those instances and in some subsequent patients the electrodes used were hypodermic needles placed into the skin of the chest wall. The pulse generator was a Grass physiologic stimulator. The patient recorded in this contemporary film was not identified but certainly was one of the early patients, before Zoll began to use flat metal ECG electrodes to stimulate. This silent and unannotated 16 mm film done fifty years ago, had been stored and been forgotten until its recent rediscovery.
View Film » (Running time: 5:48)
Note: You will need to have the free Real Player plug-in to listen to the narration.
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Emergency Transvenous Cardiac Pacing
This film made in 1974 remains remarkably modern, in part because of slower technologic evolution than has occurred with implanted cardiac pacemakers and because the basics of temporary lead insertion had been evolved by that time. The film is extremely well narrated and can function as a useful teaching tool even at this late date.
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19:48
Film donated by Doris J.W. Escher, MD
Note: You will need to have the free Windows Media Player to view the film.
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Implanted Pacemakers: Long Term Follow-Up
This film was made near the end of the era of pacemakers powered by mercury-zinc, usually in a battery of four or five such cells. Follow-up was based on their behavior: a flat output voltage until the end of service and then rapid decline in output voltage to depletion and a longevity of about one and a half to two years. Each unit had the capability of magnet application converting the unit into an asynchronous rate indicative of the state of battery consumption. Some of the follow-up was transtelephonic with transmission of the magnet application and free running ECG and the stimulation rate in both modes. Weekly transmission from the patient's home achieved accurate detection of impending before actual pacemaker failure. The advent of lithium cell powered pulse generators entirely changed their behavior and longevity.
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Film donated by Doris J.W. Escher, MD
Note: You will need to have the free Windows Media Player to view the film.
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The ECG Alphabet: The Waves of the Electrocardiogram
by A. John Camm, M.D.
S. George's Hospital Medical School
London England
From the initial recognition of cardiac electrical signals by Waller in 1887 through Einthoven's development and description of the electrocardiogram in 1902-3 the waves detected have been named with letter designations. The variety of such nomenclature and the subsequent discovery of additional waves and their naming and arrival at present usage is an interesting narrative. Dr. Camm presented this informative and light-hearted lecture at Europace in Copenhagen during June 2001.
Listen to Audio
(Running time: 19:20)
Note: You will need to have the free Real Player plug-in to listen to the narration.
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The Evolution of Clinical Electrophysiology in the Past 20 Years:
Two Decades of Insights into the Mechanisms and Treatments of Superventricular Arrythmias
by Hein J.J. Wellens, M.D.
Hein Wellens describes the discovery of the ability to controllably stimulate a cardiac accessory pathway and with that the beginning of invasive electrophysiology in Durrer's laboratory. Opportunity presented during an open heart repair of an atrial septal defect in a patient with Wolff-Parkinson-White syndrome. With the accessory pathway surgically exposed and therefore accessible to direct stimulation, a reciprocating tachycardia could be repeatedly and controllably reproduced and terminated by stimulation. This ability vindicated their hypothesis and encouraged the provocation of a variety of tachycardias and their prompt termination by controlled programmed stimulation. These discoveries encouraged others to duplicate and enlarge this investigation and subsequently develop the discipline of clinical cardiac electrophysiology.
View the Slideshow
(Running time: 19:57)
Note: You will need to have the free Real Player plug-in to listen to the narration.
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Special Notation for Paced-ECG Analysis
This presentation, based largely on lectures given by Dr. Alan Bernstein at the American College of Cardiology Learning Center in Bethesda, addresses three techniques for "modeling" the interaction between an antibradycardia pacemaker and the cardiac conduction system. They include overlay diagrams and programming-summary templates, developed jointly by Dr. Bernstein and Dr. Victor Parsonnet at the Newark Beth Israel Medical Center in New Jersey, and "state diagrams," which are used in engineering as graphical models of the operation of systems of various types, and are applied here to several pacing modes.
View the Slideshow
(Running time: 12:57)
Note: You will need to have the free Real Player plug-in to listen to the narration.
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Hyman's Pacemaker
By the end of the first decade of the twentieth century the AV conduction system had been described. Drug therapy for Stokes-Adams disease was being investigated and the lethal nature of the condition had been recognized. But a few physicians sought other treatments for the "stopped heart."
Albert S. Hyman (1893-1972), a practitioner cardiologist in New York City, has for decades intrigued historians of electrical stimulation of the heart, because in the early 1930s he invented an artificial pacemaker. This paper attempts to reconstruct Hyman's ideas and purposes and describe the workings and limitations of the invention. Continue Reading »
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Pacemaker, Defibrillator, and Lead Codes
In clinical pacing, as in other fields, clear and efficient communication is a necessary resource. In 1974, the Inter-Society Commission for Heart Disease Resources addressed an increasingly apparent need for a concise way of communicating three pacemaker fundamentals: the chamber or chambers paced, the chamber or chambers in which native depolarizations were sensed, and how sensing affected pacing patterns. They introduced the three-position ICHD Code. Continue Reading »
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Centro de Construccion de Cardioestimuladores del Uruguay: Origins and Objectives
During the 1960s, few implantations were performed in Uruguay because of the extremely high costs of imported pacemakers. By 1969, in an attempt to solve the problem of cost, local production of pacemakers was begun by the Centro de Construccion de Cardioestimuladores del Uruguay (C.C.C.) founded by Orestes Fiandra, MD. Initial production was difficult as pacemaker manufacture requires precision technology without margin for error. As C.C.C. overcame these problems manufacture of high quality product became possible. Continue Reading »
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World Symposia of Cardiac Pacing and Electrophysiology
This section presents compiled information on each World Symposium held since 1963. Details regarding the organizer, the number of attendees, the venue and major topics and/or events is listed for each year the symposium was held, along with additional information and photographs where available. Also included are the references for the proceedings book for each year. Continue Reading »
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The Work of Barouh V. Berkovits
Between the late 1950s and the mid-1960s, while at the medical appliance division of American Optical Company, engineer Barouh V. Berkovits invented a heart monitor, the first closed-chest DC defibrillator, and the DC cardioverter. Berkovits then invented the "demand" or VVI pacemaker, first as an external device, then in an implantable configuration. Continue Reading »
This material honoring Berkovits' career was first displayed at the NASPE History Theater at the NASPE 22nd Annual Scientific Sessions in Boston, Massachusetts in May, 2001. We want to acknowledge the contribution of Agustin Castellanos in preparing this material.
See also: Biography of Barouh Berkovits
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The Work of Howard B. Burchell, MD
Dr. Burchell and his colleagues set the stage for ablation of accessory AV connections and ultimately led to the current era of interventional cardiac electrophysiology. Dr. Burchell's career bibliography exceeds 400 publications, ranging in topics from changes in the form of the beating mammalian heart to the treatment of preexcitation syndrome. Continue Reading »
This material honoring Dr. Burchell's career was first displayed at the NASPE History Theater at the NASPE 23rd Annual Scientific Sessions in San Diego, California in May 2002. We want to acknowledge the contributions of Ronald E. Vlietstra, MD and David G. Benditt, MD in preparing this material.
See also: Biography of Howard Burchell
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The Work of Paul M. Zoll, MD
With an epochal publication in 1952, Paul M. Zoll, MD described cardiac resuscitation via electrodes on the bare chest. This initial clinical description launched the widespread evaluation of pacing and the recognition that the asystole heart could be stimulated to beat. In 1956, his use of an alternating current shock began clinical cardioversion-defibrillation. He was involved early on in the development of emergency pacing and defibrillation, both of which benefited from his repetitive pioneering efforts. Continue Reading »
This material honoring the career of Paul M. Zoll, MD was first displayed in the NASPE History Theater at the NASPE 22nd Annual Scientific Sessions in Boston, Massachusetts in May 2001. We would like to acknowledge the contributions of Stafford Cohen, MD in preparing this material.
See also: Biography of Paul Zoll
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The Work of Augustus Desiré Waller
In the late 19th and early 20th centuries, Augustus Desiré Waller's pioneering work in the recording of the electrical systems of the human heart was the foundation of the ECGs of today. His 1887 article "A Demonstration on Man of Electromotive Changes Accompanying the Heart's Beat" is regarded as the first published account of human electrocardiography. In 1917 he presented a paper before the Physiological Society of London in titled "A Preliminary Survey of 2,000 Electrocardiograms" and it is this paper which coined the term "electrocardiogram." Continue Reading »
This material honoring the career of Waller was first displayed in the NASPE History Theater at the NASPE 23rd Annual Scientific Sessions in Washington, DC in May 2003. We would like to acknowledge the contributions of Ronald E. Vlietstra, MD in preparing this material.
See also: Biography of Augustus Desiré Waller
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Posters
These 12" x 48" posters are available for purchase through The Furman Fund of the Heart Rhythm Foundation. Please contact Betsy Bogdansky, bbogdansky@HRSonline.org or (202) 464-3454 for more information.
Poster Honoring Brian F. Hoffman, MD, "the father of experimental electrophysiology" —
During Heart Rhythm 2011 the Society's history theater, Rhythms in Time, focused on the work and far-reaching influence of Brian F. Hoffman, MD (1925 – ). Dr. Hoffman is admired for his intellectual grasp of the entire field — from biophysical studies of basic mechanisms through clinical studies of arrhythmias. The exhibit poster — view online (PDF, 987K) honoring Dr. Hoffman and some of the many colleagues he instructed and mentored was a focal point of Heart Rhythm Place.
See also: Biography of Brian F. Hoffman
Poster Honoring Anthony N. Damato, MD and the Staten Island U.S. Public Health Service Hospital —
During Heart Rhythm 2010 the Society's history theater, Rhythms in Time, focused on the work of Anthony N. Damato, MD (1930 – 2001). Dr. Damato was among the first to recognize the development of modern cardiac electrophysiology, and arrhythmia investigation and management and he trained a group of cardiac fellows who were among the founders of clinical cardiac electrophysiology. The exhibit poster — view online (PDF, 810K) honoring Dr. Damato and the colleagues he mentored at the Staten Island U.S. Public Health Service Hospital (the first clinical electrophysiology laboratory in the United States) was a focal point of Heart Rhythm Place.
See also: Biography of Anthony N. Damato
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