Premature ventricular contraction historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Radwa AbdElHaras Mohamed AbouZaied, M.B.B.S[2]
Overview
Historical Perspective
- During the second century BC, Herophilus, a Greek anatomist and physician described what is known today as extrasystoles, which was called “intermittent pulse” by his successors.
- Later, Galen (132-201 AD) became interested in studying this abnormality and he hypothesized a link between intermittent pulse and death and was considered an ominous sign. His teachings remained unrevised till around the 17th century.
- Between the 17th and the 19th century, authors, still influenced by Galen’s tenets, were more interested in describing the character of the intermittent pulse rather than researching the cause behind it. Writers during this period still linked intermittent pulse to subsequent cardiac or medical conditions and confirmed that is in fact a manifestation of disease.
- In 1899, Cushny and Wenckebach were the first known to postulate that intermittent pulse was actually caused by extrasystoles. This discovery was only made possible in the light of the development of the cardiac science of electrophysiology growing big in the 20th century utilizing animal physiology labs. The theory was also approved at that time by by Hering, Pan and Trendelenburg. Wenckebach believed that intermittent pulse was not a caused by disturbance of pulse, but in fact a problem with cardiac function.
- Einthoven, 1906, unleashed a new era in the understanding of extra-systoles by recording the fist extrasystole using the string of a galvanometer.
- It was not before the 20th century that the Galenic teachings were challenged by some authors like Mackenzie, Lewis and Osler, who described extra-systoles as a benign phenomenon in the absence of other cardiac manifestations. This belief started to grow in Cardiology texts during the late 1960’s, that extra-systoles can occur in normal persons and is not a manifestation of disease. In 1968, and by the development in the science of electrophysiology, it was possible to describe the origin of the extrasystole, and scientists were particularly concerned about those originating from the ventricles.
- In 1969, results of a widely publicized observation study which including an entire population of Tecumseh city (1959-1965), 2.8% was the incidence rate of death in subjects with ventricular ectopy in contrast to 1.3% among normal subjects, a difference not clinically significant. Many of the subjects with ventricular ectopy resulting in death were suffering coronary artery disease. Thus, this study made evident that not all patients exhibiting ventricular ectopy are alike and they can be sub-grouped into categories with different prognosis.
- However, in practice, clinicians in the late 1970's still viewed all ventricular ectopy as a potential cause of sudden death and used to admit all patients to CCU to be treated with antiarrhythmic drugs. Premature ventricular conduction has since then being regarded as an area of debate given the clinical significance and versatility of patient subsets each exhibiting different prognosis.[1]
References
- ↑ Horan, M. J. (February 1984). "Ventricular ectopy. History, epidemiology, and clinical implications". The Journal of the American Medical Association. 251: 380–386.