Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi.

Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').

Early repolarization: an evolving concept for the past 70 years.

For more than 70 years, early repolarization has been considered to be a common normal variant. In the general population, the prevalence ranges between 5 and 13%, and in athletes, a rising trend is observed from 20 to 90%. Nevertheless, from the latter half of the 1990s, a growing number of case reports, series, observational and prospective studies reported that the presence of various electrocardiographic patterns attributed to early repolarization may constitute a potential marker for the increased risk of sudden death in otherwise normal individuals, casting a dark shadow on this ECG peculiarity. This review provides a historical summary of the evolution of the concept of early repolarization from its original description to the latest works and a guide to help physicians in evaluating individuals with this common electrocardiographic pattern.

Sudden cardiac death--historical perspectives.

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time.

George Ralph Mines, ventricular fibrillation and the discovery of the vulnerable period.

The discovery of the vulnerable period of the ventricle unmasked one of the major electrical properties of the heart. Since its description by George Ralph Mines in 1914, it has become a crucial concept in understanding the electrophysiologic basis for ventricular fibrillation. Mines also proposed the theoretical basis for the occurrence of reentrant arrhythmias. Although these concepts are widely known, Mines himself remains an obscure figure since his own sudden death at a young age. Mines was a talented researcher who had a short but prolific career in electrophysiology. The historical importance of his work lies in the influence he had on our understanding and treatment of cardiac arrhythmias as well as in the experimental methods he developed, which inspired a new era of quantitative thinking in electrophysiology.

[Did Emperior Tiberius die from myocardial infarction?]. / Un nouveau diagnostic pour la mort de Tibère.

In Svetonius' Life of the Twelve Cesars, in Tacitus' Annals, and in Dio, Cassius' Roman History, arguments can be found for the diagnosis of myocardial infarction in the case of the Roman emperor Tiberius. After violent and repeated efforts he felt an intense thoracic pain, and from that moment he became very ill and had to be carried in a litter. The course of the disease was marked by several syncopes with apparent death, some of long duration, but with spontaneous total recovery, except for the last one (which occured when getting out of bed). Moreover, we know he had abnormalities of the pulse indicating a lethal prognosis. The most logical explanation is: myocardial infarction complicated with access of ventricular tachycardia, the last one ending in ventricular fibrillation.

Automatic implantable cardioverter-defibrillator: history and future developments.

The clinical experience with automatic internal defibrillation is now extensive, with over 65,000 patients treated since the first implantation in 1980. The success of the technique is largely the result of the perseverance and foresight of Dr. Michel Mirowski, although many people were eventually involved. The author was privileged to participate almost from the very inception of the project. The early experiments and some of the difficulties along the way leading up to the present extensive favorable human experience are described.

The role of an engineering oriented medical research group in developing improved methods and devices for achieving ventricular defibrillation: the University of Missouri experience.

Physical scientists and engineers have played important roles in helping to expand our understanding of the factors that influence the defibrillation process and in developing improved methods and devices for achieving cardiac ventricular defibrillation. The long-term experience of one engineering oriented group, based in a clinical department of a medical school, is summarized. Emphasized are the features of a series of research defibrillators that facilitated the generation of an extensive experimental database from studies in dogs and calves, the development of the first automatic implantable defibrillator to be successfully used in dogs, and studies that furnished the rationale for the widespread use of the uniphasic truncated exponential waveform and for the increasing interest in a variety of biphasic and multiphasic waveforms. Also considered are studies concerning the scaling of the defibrillatory shock with subject size and the role of compound units, defibrillation threshold, and contour graphs in the presentation and interpretation of data.