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A Concise History of the ECG: Difference between revisions
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Einthoven starts transmitting electrocardiograms from the hospital to his laboratory 1.5 km away via telephone cables. On March 22nd the first 'telecardiogram' is recorded from a healthy and vigorous man and the tall R waves are attributed to his cycling from laboratory to hospital for the recording. | Einthoven starts transmitting electrocardiograms from the hospital to his laboratory 1.5 km away via telephone cables. On March 22nd the first 'telecardiogram' is recorded from a healthy and vigorous man and the tall R waves are attributed to his cycling from laboratory to hospital for the recording. | ||
'''1905''' John Hay of Liverpool, publishes pressure recordings from a 65 year old man showing heart block in which AV conduction did not seem to be impaired since the a-c intervals on the jugular venous waves was unchanged in the conducted beats. This is the first demonstration of what we now call Mobitz type II AV block. Hay | '''1905''' John Hay of Liverpool, publishes pressure recordings from a 65 year old man showing heart block in which AV conduction did not seem to be impaired since the a-c intervals on the jugular venous waves was unchanged in the conducted beats. This is the first demonstration of what we now call Mobitz type II AV block. <cite>Hay</cite> | ||
'''1906''' Einthoven publishes the first organised presentation of normal and abnormal electrocardiograms recorded with a string galvanometer. Left and right ventricular hypertrophy, left and right atrial hypertrophy, the U wave (for the first time), notching of the QRS, ventricular premature beats, ventricular bigeminy, atrial flutter and complete heart block are all described. Einthoven W. Le telecardiogramme. Arch Int de Physiol 1906;4:132-164 (translated into English. Am Heart J 1957;53:602-615) | '''1906''' Einthoven publishes the first organised presentation of normal and abnormal electrocardiograms recorded with a string galvanometer. Left and right ventricular hypertrophy, left and right atrial hypertrophy, the U wave (for the first time), notching of the QRS, ventricular premature beats, ventricular bigeminy, atrial flutter and complete heart block are all described. Einthoven W. Le telecardiogramme. Arch Int de Physiol 1906;4:132-164 (translated into English. Am Heart J 1957;53:602-615) | ||
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'''1908''' Edward Schafer of the University of Edinburgh is the first to buy a string galvanometer for clinical use. | '''1908''' Edward Schafer of the University of Edinburgh is the first to buy a string galvanometer for clinical use. | ||
'''1909''' Thomas Lewis of University College Hospital, London buys a string galvanometer and so does Alfred Cohn of Mt Sinae Hospital, New York. Thomas Lewis publishes a paper in the BMJ detailing his careful clinical and electrocardiographic observations of atrial fibrillation. At one point Lewis identified a fibrillating horse using the string galvanometer's electrocardigram recording. He then followed the horse to the slaughterhouse where he could visually confirm the fibrillating atrium. Lewis | '''1909''' Thomas Lewis of University College Hospital, London buys a string galvanometer and so does Alfred Cohn of Mt Sinae Hospital, New York. Thomas Lewis publishes a paper in the BMJ detailing his careful clinical and electrocardiographic observations of atrial fibrillation. At one point Lewis identified a fibrillating horse using the string galvanometer's electrocardigram recording. He then followed the horse to the slaughterhouse where he could visually confirm the fibrillating atrium. <cite>Lewis</cite> | ||
'''1909''' Nicolai and Simmons report on the changes to the electrocardiogram during angina pectoris. Nicolai DF, Simons A. (1909) Zur klinik des elektrokardiogramms. Med Kiln 5;160 | '''1909''' Nicolai and Simmons report on the changes to the electrocardiogram during angina pectoris. Nicolai DF, Simons A. (1909) Zur klinik des elektrokardiogramms. Med Kiln 5;160 | ||
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'''1912''' Einthoven addresses the Chelsea Clinical Society in London and describes an equilateral triangle formed by his standard leads I, II and III later called 'Einthoven's triangle'. This is the first reference in an English article I have seen to the abbreviation 'EKG'.Einthoven W. The different forms of the human electrocardiogram and their signification. Lancet 1912(1):853-861 | '''1912''' Einthoven addresses the Chelsea Clinical Society in London and describes an equilateral triangle formed by his standard leads I, II and III later called 'Einthoven's triangle'. This is the first reference in an English article I have seen to the abbreviation 'EKG'.Einthoven W. The different forms of the human electrocardiogram and their signification. Lancet 1912(1):853-861 | ||
'''1918''' Bousfield describes the spontaneous changes in the electrocardiogram during angina. Bousfield | '''1918''' Bousfield describes the spontaneous changes in the electrocardiogram during angina. <cite>Bousfield</cite> | ||
'''1920''' Hubert Mann of the Cardiographic Laboratory, Mount Sinai Hospital, describes the derivation of a 'monocardiogram' later to be called 'vectorcardiogram'. Mann | '''1920''' Hubert Mann of the Cardiographic Laboratory, Mount Sinai Hospital, describes the derivation of a 'monocardiogram' later to be called 'vectorcardiogram'. <cite>Mann</cite> | ||
'''1920''' Harold Pardee, New York, publishes the first electrocardiogram of an acute myocardial infarction in a human and describes the T wave as being tall and "starts from a point well up on the descent of the R wave". <cite>Pardee</cite> | '''1920''' Harold Pardee, New York, publishes the first electrocardiogram of an acute myocardial infarction in a human and describes the T wave as being tall and "starts from a point well up on the descent of the R wave". <cite>Pardee</cite> | ||
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'''1934''' By joining the wires from the right arm, left arm and left foot with 5000 Ohm resistors Frank Wilson defines an 'indifferent electrode' later called the 'Wilson Central Terminal'. The combined lead acts as an earth and is attached to the negative terminal of the ECG. An electrode attached to the positive terminal then becomes 'unipolar' and can be placed anywhere on the body. Wilson defines the unipolar limb leads VR, VL and VF where 'V' stands for voltage (the voltage seen at the site of the unipolar electrode). <cite>Wilson</cite> | '''1934''' By joining the wires from the right arm, left arm and left foot with 5000 Ohm resistors Frank Wilson defines an 'indifferent electrode' later called the 'Wilson Central Terminal'. The combined lead acts as an earth and is attached to the negative terminal of the ECG. An electrode attached to the positive terminal then becomes 'unipolar' and can be placed anywhere on the body. Wilson defines the unipolar limb leads VR, VL and VF where 'V' stands for voltage (the voltage seen at the site of the unipolar electrode). <cite>Wilson</cite> | ||
'''1935''' McGinn and White describe the changes to the electrocardiogram during acute pulmonary embolism including the S1 Q3 T3 pattern. McGinn | '''1935''' McGinn and White describe the changes to the electrocardiogram during acute pulmonary embolism including the S1 Q3 T3 pattern. <cite>McGinn</cite> | ||
'''1938''' American Heart Association and the Cardiac Society of Great Britain define the standard positions, and wiring, of the chest leads V1 - V6. The 'V' stands for voltage. Barnes AR, Pardee HEB, White PD. et al. Standardization of precordial leads. Am Heart J 1938;15:235-239 | '''1938''' American Heart Association and the Cardiac Society of Great Britain define the standard positions, and wiring, of the chest leads V1 - V6. The 'V' stands for voltage. Barnes AR, Pardee HEB, White PD. et al. Standardization of precordial leads. Am Heart J 1938;15:235-239 | ||
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'''1947''' Gouaux and Ashman describe an observation that helps differentiate aberrant conduction from ventricular tachycardia. The 'Ashman phenomenon' occurs when a stimulus falls during the relative or absolute refractory period of the ventricles and the aberrancy is more pronounced. In atrial fibrillation with aberrant conduction this is demonstrated when the broader complexes are seen terminating a relatively short cycle that follows a relatively long one. The QRS terminating the shorter cycle is conducted 'more aberrantly' because it falls in the refractory period. The aberrancy is usually of a RBBB pattern. <cite>Gouaux</cite> | '''1947''' Gouaux and Ashman describe an observation that helps differentiate aberrant conduction from ventricular tachycardia. The 'Ashman phenomenon' occurs when a stimulus falls during the relative or absolute refractory period of the ventricles and the aberrancy is more pronounced. In atrial fibrillation with aberrant conduction this is demonstrated when the broader complexes are seen terminating a relatively short cycle that follows a relatively long one. The QRS terminating the shorter cycle is conducted 'more aberrantly' because it falls in the refractory period. The aberrancy is usually of a RBBB pattern. <cite>Gouaux</cite> | ||
'''1947''' Claude Beck, a pioneering cardiovascular surgeon in Cleveland, successfully defibrillates a human heart during cardiac surgery. The patient is a 14 year old boy - 6 other patients had failed to respond to the defibrillator. His prototype defibrillator followed experiments on defibrillation in animals performed by Carl J. Wiggers, Professor of Physiology at the Western Reserve University. Beck | '''1947''' Claude Beck, a pioneering cardiovascular surgeon in Cleveland, successfully defibrillates a human heart during cardiac surgery. The patient is a 14 year old boy - 6 other patients had failed to respond to the defibrillator. His prototype defibrillator followed experiments on defibrillation in animals performed by Carl J. Wiggers, Professor of Physiology at the Western Reserve University. <cite>Beck</cite> | ||
'''1948''' Rune Elmqvist, Swedish engineer who had trained as a doctor but never practiced, introduces the first ink jet printer for the transcription of analog physiological signals. He demonstrates its use in the recording of ECGs at the First International Congress of Cardiology in Paris in 1950. The machine (the mingograph) was developed by him at the company that later became Siemens. (Luderitz, 2002) | |||
1948 | |||
Rune Elmqvist, Swedish engineer who had trained as a doctor but never practiced, introduces the first ink jet printer for the transcription of analog physiological signals. He demonstrates its use in the recording of ECGs at the First International Congress of Cardiology in Paris in 1950. The machine (the mingograph) was developed by him at the company that later became Siemens. (Luderitz, 2002) | |||
'''1949''' Montana physician Norman Jeff Holter develops a 75 pound backpack that can record the ECG of the wearer and transmit the signal. His system, the Holter Monitor, is later greatly reduced in size, combined with tape / digital recording and used to record ambulatory ECGs. <cite>Holter</cite> | '''1949''' Montana physician Norman Jeff Holter develops a 75 pound backpack that can record the ECG of the wearer and transmit the signal. His system, the Holter Monitor, is later greatly reduced in size, combined with tape / digital recording and used to record ambulatory ECGs. <cite>Holter</cite> | ||
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'''1949''' Sokolow and Lyon propose diagnostic criteria for left ventricular hypertrophy i.e. LVH is present if the sum of the size of the S wave in V1 plus the R wave in V6 exceeds 35 mm. <cite>Sokolow</cite> | '''1949''' Sokolow and Lyon propose diagnostic criteria for left ventricular hypertrophy i.e. LVH is present if the sum of the size of the S wave in V1 plus the R wave in V6 exceeds 35 mm. <cite>Sokolow</cite> | ||
'''1950''' John Hopps, a Canadian electrical engineer and researcher for the National Research Council, together with two physicians (Wilfred Bigelow, MD of the University of Toronto and his trainee, John C. Callaghan, MD) show that a coordinated heart muscle contraction can be stimulated by an electrical impulse delivered to the sino-atrial node. The apparatus, the first cardiac pacemaker, measures 30cm, runs on vacuum tubes and is powered by household 60Hz electrical current. Bigelow | '''1950''' John Hopps, a Canadian electrical engineer and researcher for the National Research Council, together with two physicians (Wilfred Bigelow, MD of the University of Toronto and his trainee, John C. Callaghan, MD) show that a coordinated heart muscle contraction can be stimulated by an electrical impulse delivered to the sino-atrial node. The apparatus, the first cardiac pacemaker, measures 30cm, runs on vacuum tubes and is powered by household 60Hz electrical current. <cite>Bigelow</cite> | ||
'''1953''' Osborn, whilst experimenting with hypothermic dogs, describes the prominent J (junctional) wave which has often been known as the "Osborn wave". He found the dogs were more likely to survive if they had an infusion of bicarbonate and supposed the J wave was due to an injury current caused by acidosis. Osborn JJ. Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 1953;175:389. | '''1953''' Osborn, whilst experimenting with hypothermic dogs, describes the prominent J (junctional) wave which has often been known as the "Osborn wave". He found the dogs were more likely to survive if they had an infusion of bicarbonate and supposed the J wave was due to an injury current caused by acidosis. Osborn JJ. Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 1953;175:389. | ||
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'''1960''' Smirk and Palmer highlight the risk of sudden death from ventricular fibrillation particularly when ventricular premature beats occur at the same time as the T wave. The 'R on T' phenomenon. Smirk FH, Palmer DG. A myocardial syndrome, with particular reference to the occurrence of sudden death and of premature systoles interrupting antecedent T waves. Am J Cardiol 1960;6:620. | '''1960''' Smirk and Palmer highlight the risk of sudden death from ventricular fibrillation particularly when ventricular premature beats occur at the same time as the T wave. The 'R on T' phenomenon. Smirk FH, Palmer DG. A myocardial syndrome, with particular reference to the occurrence of sudden death and of premature systoles interrupting antecedent T waves. Am J Cardiol 1960;6:620. | ||
'''1963''' Italian paediatrician C. Romano and Irish paediatrician O. Conor Ward (the following year) independently report an autosomal dominant syndrome of long-QT interval later known as the Romano-Ward syndrome. Romano | '''1963''' Italian paediatrician C. Romano and Irish paediatrician O. Conor Ward (the following year) independently report an autosomal dominant syndrome of long-QT interval later known as the Romano-Ward syndrome. <cite>Romano</cite><cite>Ward</cite> | ||
'''1963''' Robert Bruce and colleages describe their multistage treadmill exercise test later known as the Bruce Protocol. "You would never buy a used car without taking it out for a drive and seeing how the engine performed while it was running," Bruce says, "and the same is true for evaluating the function of the heart." | '''1963''' Robert Bruce and colleages describe their multistage treadmill exercise test later known as the Bruce Protocol. "You would never buy a used car without taking it out for a drive and seeing how the engine performed while it was running," Bruce says, "and the same is true for evaluating the function of the heart." <cite>Bruce1</cite><cite>Bruce2</cite> | ||
'''1963''' Baule and McFee are the first to detect the magnetocardiogram which is the electromagnetic field produced by the electrical activity of the heart. It is a method that can detect the ECG without the use of skin electrodes. Although potentially a useful technique it has never gained clinical acceptance, partly because of its greater expense. Baule | '''1963''' Baule and McFee are the first to detect the magnetocardiogram which is the electromagnetic field produced by the electrical activity of the heart. It is a method that can detect the ECG without the use of skin electrodes. Although potentially a useful technique it has never gained clinical acceptance, partly because of its greater expense. <cite>Baule</cite> | ||
'''1966''' Mason and Likar modify the 12-lead ECG system for use during exercise testing. The right arm electrode is placed at a point in the infraclavicular fossa medial to the border of the deltoid muscle, 2 cm below the lower border of the clavicle. The left arm electrode is placed similarly on the left side. The left leg electrode is placed at the left iliac crest. Although this system reduces the variability in the ECG recording during exercise it is not exactly equivalent to the standard lead positions. The Mason-Likar lead system tends to distort the ECG with a rightward QRS axis shift, a reduction in R wave amplitude in lead I and aVL, and a significant increase in R wave amplitude in leads II, III and aVF. | '''1966''' Mason and Likar modify the 12-lead ECG system for use during exercise testing. The right arm electrode is placed at a point in the infraclavicular fossa medial to the border of the deltoid muscle, 2 cm below the lower border of the clavicle. The left arm electrode is placed similarly on the left side. The left leg electrode is placed at the left iliac crest. Although this system reduces the variability in the ECG recording during exercise it is not exactly equivalent to the standard lead positions. The Mason-Likar lead system tends to distort the ECG with a rightward QRS axis shift, a reduction in R wave amplitude in lead I and aVL, and a significant increase in R wave amplitude in leads II, III and aVF. <cite>Papouchado</cite> | ||
'''1966''' François Dessertenne of Paris publishes the first case of '[[Torsade de pointes]]' Ventricular Tachycardia. <cite>Dessertenne</cite> | '''1966''' François Dessertenne of Paris publishes the first case of '[[Torsade de pointes]]' Ventricular Tachycardia. <cite>Dessertenne</cite> | ||
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'''1968''' Henry Marriott introduces the Modified Chest Lead 1 (MCL1) for monitoring patients in Coronary Care. | '''1968''' Henry Marriott introduces the Modified Chest Lead 1 (MCL1) for monitoring patients in Coronary Care. | ||
'''1969''' Rosenbaum reviews the classification of ventricular premature beats and adds a benign form that arises from the right ventricle and is not associated with heart disease. This becomes known as the 'Rosenbaum ventricular extrasystole'. Rosenbaum | '''1969''' Rosenbaum reviews the classification of ventricular premature beats and adds a benign form that arises from the right ventricle and is not associated with heart disease. This becomes known as the 'Rosenbaum ventricular extrasystole'. <cite>Rosenbaum</cite> | ||
'''1974''' Jay Cohn, of University of Minnesota Medical School, describes the 'syndrome of right ventricular dysfunction in the setting of acute inferior wall myocardial infarction'. Cohn | '''1974''' Jay Cohn, of University of Minnesota Medical School, describes the 'syndrome of right ventricular dysfunction in the setting of acute inferior wall myocardial infarction'. <cite>Cohn</cite> | ||
'''1974''' Gozensky and Thorne introduce the term 'Rabbit ears' to electrocardiography. Rabbit ears describe the appearence of the QRS complex in lead V1 with an rSR' pattern (good rabbit) being typical of Right Bundle Branch Block and an RSr' (bad rabbit) suggesting a ventricular origin i.e. ventricular ectopy / tachycardia. <cite>Gozensky</cite> | '''1974''' Gozensky and Thorne introduce the term 'Rabbit ears' to electrocardiography. Rabbit ears describe the appearence of the QRS complex in lead V1 with an rSR' pattern (good rabbit) being typical of Right Bundle Branch Block and an RSr' (bad rabbit) suggesting a ventricular origin i.e. ventricular ectopy / tachycardia. <cite>Gozensky</cite> | ||
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#Sokolow pmid=18107386 | #Sokolow pmid=18107386 | ||
#Hyman Hyman AS. ''Resuscitation of the stopped heart by intracardial therapy.'' Arch Intern Med. 1932;50:283 | #Hyman Hyman AS. ''Resuscitation of the stopped heart by intracardial therapy.'' Arch Intern Med. 1932;50:283 | ||
#Lewis Lewis T. ''Auricular fibrillation: a common clinical condition.'' BMJ 1909;42:1528. | |||
#Hay Hay J. ''Bradycardia and cardiac arrhythmias produced by depression of certain functions of the heart.'' Lancet 1906;1:138-143. | |||
#Bousfield Bousfield G. ''Angina pectoris: changes in electrocardiogram during paroxysm.'' Lancet 1918;2:475 | |||
#Mann Mann H. ''A method of analyzing the electrocardiogram.'' Arch Int Med 1920;25:283-294 | |||
#McGinn McGinn S, White PD. ''Acute cor pulmonale resulting from pulmonary embolism: its clinical recognition.'' JAMA 1935;114:1473. | |||
#Bigelow pmid=15433219 | |||
#Romano pmid=14158288 | |||
#Ward pmid=14136838 | |||
#Bruce1 pmid=14070531 | |||
#Bruce2 pmid=5261245 | |||
#Baule pmid=14045992 | |||
#Papouchado pmid=3653124 | |||
#Rosenbaum pmid=4189497 | |||
#Cohn pmid=4810018 | |||
#Beck Beck CS, Pritchard WH, Feil SA: ''Ventricular fibrillation of long duration abolished by electric shock.'' JAMA 1947; 135: 985-989. | |||
#Wiggers Wiggers CJ, Wegria R. ''Ventricular fibrillation due to single localized induction in condenser shock supplied during the vulnerable phase of ventricular systole.'' Am J Physiol 1939;128:500 | |||
</biblio> | </biblio> | ||