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History of Medicine |

From Delirium Cordis to Atrial Fibrillation: Historical Development of a Disease Concept

Kenneth M. Flegel, MD
[+] Article and Author Information

From the Royal Victoria Hospital and McGill University, Montreal, Quebec, Canada. Requests for Reprints: Not available to readers in North America and Western Europe. Requests from other parts of the world may be sent to Dr. Kenneth Flegel, Division of General Internal Medicine, Room A4.21, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(11):867-873. doi:10.7326/0003-4819-122-11-199506010-00010
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In 1874, the electrical stimulation of animal hearts made known the existence of atrial fibrillation, but atrial fibrillation was not associated with its clinical counterpart, arrhythmia perpetua, until 1909, by which time simultaneous recordings of the human heartbeat, the venous and arterial pulses, and electrocardiographic activity had revealed the common origin of these events.After the electrical basis of atrial fibrillation was found and after atrial fibrillation was clearly distinguished from ventricular fibrillation, investigation into its mechanism ensued. Two contrasting theories, that of circus movement and that of tachysystole from a single focus, led to 30 years of research and debate. Pivotal to the argument was the notion of blocked conduction. Although the theory of circus movement prevailed for a long time, it appeared to be demolished by electrophysiologic experiments done between 1948 and 1950. The realization that blocked conduction could later reenter led to more recent research in animals and humans that revived the notion of circular conduction, although in a much more sophisticated form.

Figures

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Figure 1.
The first electrocardiographic recording of atrial fibrillation showing F waves.[31]

In the paper that accompanied this recording, Hering remarked that no atrial activity was evident, meaning that no P waves could be seen .

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Figure 2.
Schematic drawing of a way in which reentry could occur.[62]

A penultimate twig (D) of the atrioventricular bundle is shown; anastomoses with ventricular muscle are at B and C. Conduction at AB would be monodromic: impossible in the direction of the atrioventricular node but almost normal in the opposite direction. An impulse from D would be blocked at A but, by way of the other terminal branch, could travel in the BA direction, ultimately to reach and stimulate muscle at C .

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