The state of electrical cardiac stimulation — 1995

Abstract

Electrical stimulation of the heart for asystole or ventricular fibrillation has been a topic of intense scientific interest for several centuries [1]. It has been recognized since the mid 19th century that cardiac contraction would sustain itself and that if the fibrillating heart became asystolic it might then resume a “normal” rhythmic contraction [2]. By the end of the 19th century it had been demonstrated that the heart could be stimulated electrically to contract and that ventricular fibrillation could be ended by an electric discharge with return to coordinated contraction and rhythm [3]. During the succeeding decades, stimulating the asystolic heart and terminating ventricular fibrillation by electrical stimulation, usually through the closed chest, but also by direct application of a large condenser discharge to the heart, was repeated in the laboratory [4] and in the operating room [5]. Chest wall transcutaneous needle puncture, transcutaneous pacing [6], temporary epicardial pacing [7] and transvenous pacing [8] were all introduced. The concept of electrical stimulation to terminate ventricular arrhythmias and to stimulate the heart to contract were recognized as related approaches to cardiac rhythm management during the middle of the 20th century [9]. Such a concept is now widely accepted.