Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi

Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').

Sudden cardiac death--historical perspectives

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time.

Resuscitation in the past, the present and the future

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[Did Emperior Tiberius die from myocardial infarction?]

In Svetonius' Life of the Twelve Cesars, in Tacitus' Annals, and in Dio, Cassius' Roman History, arguments can be found for the diagnosis of myocardial infarction in the case of the Roman emperor Tiberius. After violent and repeated efforts he felt an intense thoracic pain, and from that moment he became very ill and had to be carried in a litter. The course of the disease was marked by several syncopes with apparent death, some of long duration, but with spontaneous total recovery, except for the last one (which occured when getting out of bed). Moreover, we know he had abnormalities of the pulse indicating a lethal prognosis. The most logical explanation is: myocardial infarction complicated with access of ventricular tachycardia, the last one ending in ventricular fibrillation.

George Ralph Mines, ventricular fibrillation and the discovery of the vulnerable period

The discovery of the vulnerable period of the ventricle unmasked one of the major electrical properties of the heart. Since its description by George Ralph Mines in 1914, it has become a crucial concept in understanding the electrophysiologic basis for ventricular fibrillation. Mines also proposed the theoretical basis for the occurrence of reentrant arrhythmias. Although these concepts are widely known, Mines himself remains an obscure figure since his own sudden death at a young age. Mines was a talented researcher who had a short but prolific career in electrophysiology. The historical importance of his work lies in the influence he had on our understanding and treatment of cardiac arrhythmias as well as in the experimental methods he developed, which inspired a new era of quantitative thinking in electrophysiology.

The role of an engineering oriented medical research group in developing improved methods and devices for achieving ventricular defibrillation: the University of Missouri experience

Physical scientists and engineers have played important roles in helping to expand our understanding of the factors that influence the defibrillation process and in developing improved methods and devices for achieving cardiac ventricular defibrillation. The long-term experience of one engineering oriented group, based in a clinical department of a medical school, is summarized. Emphasized are the features of a series of research defibrillators that facilitated the generation of an extensive experimental database from studies in dogs and calves, the development of the first automatic implantable defibrillator to be successfully used in dogs, and studies that furnished the rationale for the widespread use of the uniphasic truncated exponential waveform and for the increasing interest in a variety of biphasic and multiphasic waveforms. Also considered are studies concerning the scaling of the defibrillatory shock with subject size and the role of compound units, defibrillation threshold, and contour graphs in the presentation and interpretation of data.