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His bundle ECG

B.J. Scherlag (54)

Fig. 2. Dog "Jimmie" on the Waller table. Waller's experiments and demonstrations were in part done with his pet bulldog "Jimmie" who was trained to stand quietly with two legs in pots of normal saline.

Fig. 3. Willem Einthoven (1860-1927) was born on May 21, 1860, the son of a military doctor in Semarang on the island of Java. After the death of his father, the family returned to the Netherlands in 1870, where Einthoven finished school and started medical school at the University of Utrecht in 1879. There he earned his doctorate in 1885. The same year he became a professor of physiology and histology at the University of Leiden. Einthoven held that position until his death on September 28, 1927.

Fig. 3. Willem Einthoven (1860-1927) was born on May 21, 1860, the son of a military doctor in Semarang on the island of Java. After the death of his father, the family returned to the Netherlands in 1870, where Einthoven finished school and started medical school at the University of Utrecht in 1879. There he earned his doctorate in 1885. The same year he became a professor of physiology and histology at the University of Leiden. Einthoven held that position until his death on September 28, 1927.

Fig. 4. Einthoven's first ECG tracings. Recording of an ECG with A, B, C and D wave using a capillary electrometer (upper registration). The lower ECG registration is Einthoven's first published electrocardiographic tracing using a string galvanometer and a different nomenclature with P, Q, R, S, and T wave.

Fig. 4. Einthoven's first ECG tracings. Recording of an ECG with A, B, C and D wave using a capillary electrometer (upper registration). The lower ECG registration is Einthoven's first published electrocardiographic tracing using a string galvanometer and a different nomenclature with P, Q, R, S, and T wave.

ling, and Willem Einthoven were in the audience. Willem Einthoven (Fig. 3), a Dutch physiologist was stimulated by the presentation of Waller to further investigate cardiac electrical activity. Owing to the poor frequency response of the Lippmann capillary electrometer, Einthoven tried to refine this method for the application in cardiac electro-physiology. Using complex mathematical and physical maneuvers he succeeded in recording higher frequency curves and described the results in his first paper on the subject in 1895 (55). Initially Einthoven identified four distinct waves on the electrocardiogram (Fig. 4, A-D). However, he finally turned to another technical approach and modified the string galvanometer, an apparatus recently and independently invented by the French physicist Arsène D'Arsonval and the engineer Clement Ader (56). Einthoven's string galvanometer and his first recording were described in 1902 in a "Festschrift" for the Dutch physician Samuel Rosenstein (Fig. 4) (57). In the following years he published several papers coming from his early experiences in recordings from 6 persons to a first structured overview about normal and abnormal electrocardiograms in patients from the University Hospital Leiden including atrial fibrillation, ventricular premature contractions, ventricular bigemini, and atrial flutter (58-60).

Even though Einthoven's 600-pound apparatus was large and cumbersome, clinical researchers like Thomas Lewis quickly started to use it for the study and characterization of disorders in cardiac impulse formation and conduction including measurements of the myocardial depolarization and repolarization (Fig. 5). Parameters like PQ-, QRS- or QT-interval were investigated and in part identified as rate dependent (61). Bernhard

Fig. 5. Willem Einthoven and Sir Thomas Lewis in 1921.
Fig. 6. Dirk Durrer (1918-1984).

Luderitz for example analyzed in 1938 the QRS duration in relationship to the actual heart rate in 500 electrocardiograms in control subjects (62).

A more detailed approach to arrhythmias became available with the introduction of invasive electrophysiologic procedures which base as a heart catheter technique on the historical maneuver performed by Werner Forssmann (63). Following this pioneer, Scherlag described the first intracardiac catheter recordings of the His-bundle in 1969 (64),

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