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SPECIAL ARTICLE

Cardiac arrhythmias: The quest for a cure

A historical perspective

Cardiovascular Research Institute, Maastricht, the Netherlands

Manuscript received May 4, 2004; accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Hein J. J. Wellens, 21, Henric van Veldekeplein, 6211 TG Maastricht, the Netherlands (Email: hwellens{at}xs4all.nl).

Presented, in part, at the Third International Lecture of the American College of Cardiology in New Orleans, Louisiana, on March 9, 2004.

During the last 40 years, much progress has been made in our understanding and management of cardiac arrhythmias. A major step in the late 1960s was to combine programmed electrical stimulation of the heart with intracardiac activation recording. This allowed: 1) localization of the site of the block in the atrioventricular conduction system in patients with bradycardia; and 2) identification of the site of origin and the mechanism of supraventricular and ventricular tachycardia. Combining information from intracardiac studies with findings on the 12-lead electrocardiogram (ECG) resulted in much better localization of conduction abnormalities and arrhythmias using the ECG. This new knowledge led to the development of new therapies, such as bradycardia and antitachycardia pacing, and surgery for supraventricular and ventricular tachycardia. A very important development in the treatment of life-threatening arrhythmias was the implantable defibrillator. Growing concern about failure to protect patients at risk for dying suddenly with antiarrhythmic drugs led to a rapid increase in their number. Cure by catheter ablation became possible for patients with different types of arrhythmias. Genetic analysis allowed the identification of different monogenic arrhythmic diseases. Several challenges remain: the epidemic of atrial fibrillation, arrhythmias in heart failure, and sudden death out-of-hospital. One-fifth of all deaths are sudden and unexpected. The important issue is how we are going to prevent these unnecessary deaths from occurring.

Abbreviations and Acronyms   CAST = Cardiac Arrhythmia Suppression Trial   ECG = electrocardiogram   HF = heart failure   LBBB = left bundle branch block   LV = left ventricular   MADIT = Multicenter Automatic Defibrillator Implantation Trial   SCD-HeFT = Sudden Cardiac Death in Heart Failure Trial   WPW = Wolff-Parkinson-White

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