Sudden cardiac death historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD [3]

Overview

Sudden cardiac death (SCD) was initially described by Hippocrates, the founder of modern medicine. MacWilliam proposed the concept that SCD in human beings is due to ventricular fibrillation (VF) more than 120 years ago, during the time when the electrocardiogram was not yet invented.^[1]

The concept of evolutions on how the relationship of SCD and VF was established, the development of defibrillators was achieved, and cardiopulmonary resuscitation (CPR) methods were practiced, can provide a better description of how SCD evolved through time. ^[1]

Discovery

The importance of VF became clear after decades of exploring the scientific explanation for sudden cardiac death.

Landmark Events in the Development of Treatment Strategies

Below is a table that summarizes the historical events on how sudden cardiac death became clear.

**Table 1.Personalities With Significant Historical Contribution to the Discovery of Sudden Cardiac Death.**
Name	Image	Description

John A. MacWilliam	John A. MacWilliam. (Image courtesy of Wikipedia)	He proposed the concept of ventricular fibrillation (VF is the cause of SCD in man more than 120 years ago. He demonstrated that fibrillating heart can still be brought back to normal [[[rhythm]] with injectable pilocarpine and internal massage. These later on became the foundation for a systematic approach to cardiopulmonary resuscitation.
Hippocrates	Hippocrates. (Image courtesy of Wikipedia)	He initially described SCD as early as 4th century B.C. He stated that patients who frequently experience severe fainting attacks are more likely to die abruptly.
Lyman Brewer		He suggested that the first recorded VF was first noted in 1500 B.C. His original statements are found in Eber papyrus in Egypt.^[1]
Vesalius	Vesalius. (Image courtesy of Wikipedia)	He described the "worm-like" movements found in an animal's heart before death.
John Erichsen	Erichsen. (Image courtesy of Wikipedia)	He described VF after ligation of a dog's coronary artery.
Carl Ludwig and M Hoffa	Carl Ludwig. (Image courtesy of Wikipedia)	They demonstrated the application of electric current to induce VF in dogs.
Ziemssen		His experiments on women's heart were the first records of electric stimulation of heart in vivo.

Development of Defibrillators

**Table 2. The development of defibrillation therapy for sudden cardiac death.**
Name	Image	Description

Jean Luis Prevost and Frederic Battelli		In 1899, Swish researchers Prevost and Batteli reported that VF can be induced by low currents, and terminated by strong discharges.
William Kouwenhoven and Guy Knickerbocker	William Kouwenhoven. (Image courtesy of Wikipedia)	They observed that a second alternating current shock could still bring back the life of an electrocuted dog.
Albert Hyman and C. Henry Hyman		They invented the "Hyman Otor" which utilized an electric shock as an alternative to drug injection. This experiment was not accepted by medical community.
Claude Beck	Claude Beck. (Image courtesy of Wikipedia)	In 1947, he was the first one to use a defibrillator on a human being. He also used a procainamide along side with an alternating current.
Eskin and Klimov		They pioneered the "closed chest defibrillators which use voltages exceeding 1000 volts.
Bernard Lown and Barouh Berkovits	Bernard Lown. (Image courtesy of Wikipedia)	In 1959, they introduced the direct current defibrillation with 1000 volts of bank capacitors, and 100 to 200 Joules of energy content. Modifications to this defibrillator followed, which later on enabled the synchronized cardioversion.
McNeilly and Pemberton		In 1968, they noticed that most of mortality attributed to heart attacks occurred immediately after onset of symptoms.
Stephen Heilman and Michel Mirowski		They pioneered the implantable cardioverter defibrillator (ICD) at Mount Sinai Hospital.
Morton Mower		He is a junior cardiologist with extensive animal studies and was later on joined by Mirowski to work on an ICD. This was published after several rejections.
John Schuder		He developed the present day miniature version of ICD with reliable, low-energy, high-voltage, and biphasic waveform features.