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(Circulation. 2000;102:IV-52.)
© 2000 American Heart Association, Inc.

Special Anniversary Issue

What Have We Learned About Cardiac Arrhythmias?

Douglas P. Zipes, MD; Hein J. J. Wellens, MD

From the Krannert Institute of Cardiology (D.P.Z.), Indiana University School of Medicine and Roudebush Veterans Administration Medical Center, Indianapolis, Ind, and the Department of Cardiology (H.J.J.W.), Academic Hospital Maastricht and the Interuniversity Cardiology Institute of the Netherlands, Utrecht, Netherlands.

Correspondence to Douglas P. Zipes, MD, Krannert Institute of Cardiology, 1111 W 10th St, Indianapolis, IN 46202.

Key Words: ablation • arrhythmia • death, sudden • electrophysiology • pacemakers

No subspecialty in cardiology has undergone a more radical transformation in the last half century than has clinical cardiac electrophysiology. From the creation of the coronary care unit (CCU), with its concept of intensive monitoring of patients who have cardiac arrhythmias, to understanding the genetics of ion channel disturbances responsible for inherited cardiac arrhythmias, clinical cardiac electrophysiology has evolved into an established discipline credited with improving and saving hundreds of thousands of lives. In this review, we will highlight the top 10 significant advances responsible for this remarkable transformation.

Clinical Concepts

Ambulatory ECG
Recording the ECG in the ambulatory individual provided the ability for the first time to obtain online information in an active individual. Begun by Holter and Gengerelli¹ in 1949, the initial device weighed 85 pounds and was strapped to the back. The most modern version is implanted subcutaneously and can monitor the cardiac rhythm for long time periods.² Ambulatory ECG has led to many new insights, including an understanding of the mechanisms of sudden cardiac death, causes of syncope, and the concept of painless ischemia. All implantable pacemakers and cardioverter/defibrillators (ICDs) have the ability to record the cardiac rhythm, which is a useful adjunct to decision making.

The CCU
A major step forward in reducing death from myocardial infarction was the introduction of the CCU,³ where continuous monitoring of cardiac rhythm and hemodynamic status allowed early recognition and correction of life-threatening complications.⁴ Closed-chest cardiac massage and defibrillation became important life-saving measures, and the value of the well-trained nurse in this milieu became clear. . . . [Full Text of this Article]