Storia (o meglio preistoria ) della fibrillazione atriale

1. Storia (o megliopreistoria) dellafibrillazioneatriale Prof. Luigi Padeletti Università degli Studi di Firenze

2. “Quando l’uomo è sereno e sano la pulsazione scorre continua e costante come una accanto all’altra sono infilate le perle o un filo di giada” Ching (3000 a.C.)

3. Pen tsao or System of Medicine • Chiehpulse • “intermittent,slow,withoccasionalmissingbeats” • Tsupulse • “running, rapid, withoccasionalmissingbeats” • Tai pulse • “irregular, tremulous,beatsoccur at irregularintervals” • Li Shi-chen (1500 a.C.)

4. Polso dicroto (δίκροτοσ =doppio battito) Herophilus (300 a.C.)

5. - dicrotus - intermittens Pulsus - intercidens - deficiens - caprisans Galeno 19,410

6. ”Mors porro repentina ex intermittentibus evenit pulsibus, quo modo ex apoplexia extinguitur enim in utrisque caliditas quae in corde est, respiratione privata” Galeno 9,544

7. ”…nos tamen signum hoc non solum in pueris, & senibus, ut idem asservit Galenus, sed etiam in juvenibus, & robustis frequenter nullo modo funestum observavimus…” Lancisi (1707)

8. ”En général, de quelque espece que soient les intermissions, elles ne suffisent pas seules pour qu’on puisse prononcer sur la mort ou sur la vie” de Senac (1749)

9. Polso dicroto emorragie nasali Polso intermittente crisi diarroiche Polso inciduus crisi di sudorazione Solano de Luque (1731)

15. ”The origin of the pulse is as mysterious as the source of the Nile” Abercromby (1685)

16. ”There is just the one cause of arterial pulsation throughout the body, and that is contraction of the left ventricle. The pulsation of the artery-like vein (pulmonary artery) is similarly related to the contraction of the right ventricle…” Harvey W. (1621)

17. ”The facts above stated relative to the discordance existing between the pulsation of the heart and of the arteries , more especially as to strenght, are contrary to the more general opinion of modern physiologists who consider the action of the arteries as entirely dependent on that of the hearth.” Laennec (1819)

18. ” ... If at this time you cut the apex of the heart with a pair of scissors you will see blood flow out from the wound with each beat of the auricle. You will thus realize that the blood gets into the ventricle not through any pull exerted by the distended heart but through the driving force exerted by the beat of the auricles.” Harvey W. (1621)

19. “But I . .. have noticed, that after the heart proper, and even the right auricle were ceasing to beat and appeared on the point of death, an obscure movement, undulation/ palpitation had clearly continued in the right auricular blood itself for as long as the blood was perceptibly imbued with warmth and spirit.” Harvey W. (1621)

20. “The causes of palpitation are not the causes of the natural heart-beat" “If the auricles are strained and increased in volume they cause palpitations…” de Senac (1783)

21. “Extremely irregular action of the heart is almost pathognomonic of mitral stenosis” Adams R. (1827)

22. “Ataxia of the pulse” Bouilland (1835) “Delirium cordis” Nothnagel (1855) “Pulsus irregularis perpetuus” Hering (1903)

23. “It remains now to discuss those cases in which the hearth presents an apparently or really complete irregularity of action – cases that are often called by the name “delirium cordis”. It has long been known that such a complete iregularity of the hearth has no definite significance for the condition of the hearth itself. Many persons , especially those more advanced in years , enjoy perfect good health , and are quite able for their work,in spite of a continued extreme irregularity of the hearth.” Wenckebach KF(1904)

24. Mechanically , Mackenzie noted the absence of the presystolic ‘a’ wave seen in the jugular phlebogram during “pulsus irregularis perpetuus” “ nodal rhythm “ He described his findings as “ the most puzzling of all forms of irregularity of the hearth , where the hearth is never regular in its action , where seldom or never two beats of the same character follow onw another”

25. Fibrillation was first noted in response to strong , continuos (faradic) current application to the ventricles in 1850. A similar behavior of the atria was noted by Vulpian in 1874, who applied the term “frémissement fibrillaire”

27. “Cushny was the first to suggest auricular fibrillation might be a factor of clinical importance, and comparing the radial tracing from a human subject with the tracing from a dog in which they produced experimental fibrillation of the auricles, it was agreed that auricular fibrillation might be the cause of irregular heart action” Mackenzie (1914)

28. First published electrocardiograph of atrial fibrillation. Einthoven W (1906)

29. “Electrocardiograms taken from patients exhibiting the irregularity (pulsus irregularis perpetuus)showa number of irregular waves, apart from the ventricular curve;…They are found in no other disorder of the heart’s action.They disappear when in a paroxysmal case, the irregularity vanishes, and are therefore due to a temporary and disorderly action of some part of the heart wall…Fibrillation of the auricle yields curves which are identical in every respect…Further the waves on the experimental electrocardiograms can be shown to correspond to the fibrillary movements in the auricle… The facts point clearly to the conclusion that the irregularity in question is the result of auricular fibrillation” Lewis (1909)

30. Dear Professor Einthoven, … At present we are working at Fibrillation of the Auricles, but it is a very tough nut to crack. With kindest regards, Very sincerely, yours, Thomas Lewis. Sept. 2, 1919