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The Role of Shock-Induced Nonregenerative Depolarizations in Ventricular Fibrillation and Defibrillation: The Graded Response Hypothesis

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Cardiac Bioelectric Therapy

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The link between death and cardiac arrest was perhaps first recorded in the epic of Gilgamesh, the “oldest” written story on Earth (circa 2700 BC). “I touched his heart, but it beat no longer,” lamented Gilgamesh, the Babylonian hero-king in the Mesopotamian epic of Gilgamesh, as he witnessed the death of his best friend, Enkidu.1 Perhaps the earliest pictorial and informative description of the sudden cardiac death was discovered on the relief sculpture of the tomb of an Egyptian nobleman in the sixth dynasty (2625— 2475 BC) at Sakkara. The scene, titled “Sudden Death” by the German egyptologist von Bissing, is described by a sequence of pictorial events that lead to the sudden collapse of the Egyptian nobleman2 (Fig. 1). The later discovery of Egyptian writings on papyri (circa 1534 BC) directly linked heart beat irregularities to death: “If the heart trembles, has little power and sinks, the disease is advancing … and death is near.”3 Heartbeat irregularities as a marker of disease were also recognized and described in ancient China as can be deduced from a conversation between the “Golden Emperor” Huang Ti and his physician Ch'i Pai (circa 2600 BC) “When the pulse beats are long the constitution of the pulse is well regulated. … When the pulse is quick, and contain six beats to 1 cycle of respiration, it indicates heart trouble … and the disease becomes grave.”4

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  1. Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Hrayr S. Karagueuzian

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  1. Hrayr S. Karagueuzian
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Editors and Affiliations

  1. Department of Biomedical Engineering, Washington University, St. Louis, MO, USA

    Igor R. Efimov PhD

  2. Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA

    Mark W. Kroll PhD

  3. Cleveland Clinic Foundation, Cleveland, OH

    Patrick J. Tchou MD

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Karagueuzian, H.S. (2009). The Role of Shock-Induced Nonregenerative Depolarizations in Ventricular Fibrillation and Defibrillation: The Graded Response Hypothesis. In: Efimov, I.R., Kroll, M.W., Tchou, P.J. (eds) Cardiac Bioelectric Therapy. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-79403-7_9

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