Storia (o meglio preistoria) della Storia (o meglio preistoria) della fibrillazione atrialefibrillazione atriale

Prof. Luigi Padeletti

Università degli Studi di Firenze

“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.)

Pen tsao or System of Medicine

Polso dicroto (δίκροτοσ =doppio battito)

Herophilus (300 a.C.)

- dicrotus

- intermittens

Pulsus - intercidens

- deficiens

- caprisans

Galeno 19,410

”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

”…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)

”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)

Polso dicroto emorragie nasali

Polso intermittente crisi diarroiche

Polso inciduus crisi di sudorazione

Solano de Luque (1731)

”The origin of the pulse is as mysterious as

the source of the Nile”

Abercromby (1685)

”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)

”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)

” ... 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)

“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)

“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)

“Extremely irregular action of the heart is almost pathognomonic of mitral stenosis”

Adams R. (1827)

“Ataxia of the pulse”Bouilland (1835)

“Delirium cordis”Nothnagel (1855)

“Pulsus irregularis perpetuus”

Hering (1903)

“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)

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”

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”

“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)

First published electrocardiograph of atrial fibrillation.

Einthoven W (1906)

“Electrocardiograms taken from patients exhibiting the

irregularity (pulsus irregularis perpetuus)show a 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)

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