A (not so) brief history of

electrocardiography.
Find out how electrocuting chickens (1775), getting laboratory assistants to put
their hands in buckets of saline (1887), taking the ECG of a horses and then
observing their open heart surgey (1912), induction of indiscriminate angina
attacks (1931), and hypothermic dogs (1953) have helped to improve our
understanding of the ECG as a clinical tool. And why is the ECG labelled PQRST
(1895)?
17th and 18th
Centuries

The harnessing of electricity, observations of its effects on

animal tissues and the discovery of 'animal electricity'.

1600

William Gilbert

1646

1660

William Gilbert, Physician to Queen Elizabeth I, President of the

College of Physicians (before its Royal Charter), and creator of
the 'magnetic philosophy' introduces the term 'electrica' for
objects (insulators) that hold static electricity. He derived the
word from the Greek for amber (electra). It was known from
ancient times that amber when rubbed could lift light
materials. Gilbert added other examples such as sulphur and
was describing what would later be known as 'static electricity'
to distinguish it from the more noble magnetic force which he
saw as part of a philosophy to destroy forever the prevailing
Aristotlean view of matter. Gilbert W. De Magnete,
magneticisique corporibus, et de magno magnete tellure. [On
the Magnet, Magnetic Bodies, and the Great Magnet of the
Earth] 1600

Sir Thomas Browne, Physician, whilst writing to dispel popular ignorance in

many matters, is the first to use the word 'electricity'. Browne calls the
attractive force "Electricity, that is, a power to attract strawes or light
bodies, and convert the needle freely placed". (He is also the first to use the
word 'computer' - referring to people who compute calendars.) Browne, Sir
Thomas. Pseudodoxia Epidemica: Or, enquiries Into Very Many Received
Tenents, and Commonly Presumed Truths. 1646: Bk II, Ch. 1. London
Otto Von Guericke builds the first static electricity generator.

1662

Descarte's reflex BIU

The work of Rene Descartes, French Philosopher, is published

(after his death) and explains human movement in terms of
the complex mechanical interaction of threads, pores, passages
and 'animal spirits'. He had worked on his ideas in the 1630s
but had abandoned publication because of the persecution of
other radical thinkers such as Galileo. William Harvey had
developed similar ideas but they were never published.
Descartes R. De Homine (Treatise of Man); 1662: Moyardum &
leffen, Leiden.

1664
Jan Swammerdam, a Dutchman, disproves Descartes' mechanistic theory of
animal motion by removing the heart of a living frog and showing that it was
still able to swim. On removing the brain all movement stopped (which

would be in keeping with Descarte's theory) but then, when the frog was
dissected and a severed nerve end stimulated with a scalpel the muscles
twitched. This proved that movement of a muscle could occur without any
connection to the brain and therefore the transmission of 'animal spirits' was
not necessary.
Swammerdam's ideas were not widely known and his work was not
published until after his death. However, he wrote many letters and his
friend, Nicolaus Steno, did attack the Cartesian ideas in a lecture in Paris in
1665. Boerhaave published Swammerdam's 'Book of Nature' in the 1730s
which was translated into English in 1758.
1668
Swammerdam refines his experiments on muscle contraction
and nerve conduction and demonstrated some to notable
figures such as the Grand-Duke Cosimo of Tuscany who was
visiting Swammerdam's father's house on the Oude Schans in
Amsterdam. One experiment suspended the muscle on a brass
hook inside a glass tube with a water droplet to detect
movement and 'irritated' the nerve with a silver wire. This
produced movement of the muscle and it may have been due
to the induction of a small electrical charge - although
Swammerdam would have been unaware of this.
In the diagram opposite - a) glass tube, b) muscle, c) sliver
wire, d) brass wire, e) drop of water, f) investigator's hand.

electrical stimulation?
BIU

1729

1745

Stephen Gray, English scientist, distinguishes between conductors and

insulators of electricity. He demonstrates the transfer of static electrical
charge to a cork ball across 150 metres of wet hemp thread. Later he found
that the transfer could be achieved over greater distances by using brass
wire.
Dutch physicist Pieter van Musschenbroek discovers that a
partly filled jar with a nail projecting from a cork in its neck can
store an electrical charge. The jar is named the 'Leyden Jar'
after the place of its discovery. Ewald Georg von Kliest of
Pomerania invented the same device independently.

Leyden Jar

Using a Leyden jar in 1746, Jean-Antoine Nollet, French

physicist and tutor to the Royal family of France sends an
electrical current through 180 Royal Guards during a
demonstration to King Louis XV.

1769
Edward Bancroft, an American Scientist, suggests that the 'shock' from the
Torpedo Fish is electrical rather than mechanical in nature. He showed that
the properties of the shock were similar to those from a Leyden jar in that it
could be conducted or insulated with appropriate materials. The Torpedo fish
and other species were widely known to deliver shocks and were often used
in this way for therapeutic reasons. However, electrical theory at the time

1773

dictated that electricity would always flow through conductors and diffuse
away from areas of high charge to low charge. Since living tissues were
known to be conductors it was impossible to imagine how an imbalance of
charge could exist within an animal and therefore animals could not use
electricity for nerve conduction - or to deliver shocks. Furthermore, 'water
and electricity do not mix' so the idea of an 'electric fish' was generally not
accepted. Bancroft, E. An essay on the natural history of Guiana, London:T.
Becket and P. A. de Hondt, 1769.

John Walsh

1774

John Walsh, fellow of the Royal Society and Member of

Parliament, obtains a visible spark from an electric eel
Electrophorus electricus. The eel was out of water as it was not
possible to produce the spark otherwise. He used thin strips of
tin foil and demonstrated his technique to many colleagues and
visitors at his house in London. Unfortunately he never
published his eel experiment though he did win the Copley
medal in 1774 and 1783 for his work. The observations of
Walsh, and Bancroft before him, added to the argument that
some form of animal electricity existed. Walsh, J. On the
electric property of torpedo: in a letter to Ben. Franklin. Phil.
Trans. Royal Soc. 1773;63:478-489

The Rev. Mr Sowdon and Mr Hawes, apothecary, report on the surprising

effects of electricity in a case report of recovery from sudden death
published in the annual report of the newly founded Humane Society now
the Royal Humane Society. The Society had developed from 'The Institution
for Affording immediate relief to persons apparently dead from drowning'. It
was "instituted in the year 1774, to protect the industrious from the fatal
consequences of unforseen accidents; the young and inexperienced from
being sacrificed to their recreations; and the unhappy victims of desponding
melancholy and deliberate suicide; from the miserable consequences of selfdestruction."
A Mr Squires, of Wardour Street, Soho lived opposite the house from which a
three year old girl, Catherine Sophia Greenhill had fallen from the first
storey window on 16th July 1774. After the attending apothecary had
declared that nothing could be done for the child Mr Squires, "with the
consent of the parents very humanely tried the effects of electricity. At least
twenty minutes had elapsed before he could apply the shock, which he gave
to various parts of the body without any apparent success; but at length,
upon transmitting a few shocks through the thorax, he perceived a small
pulsation: soon after the child began to sigh, and to breathe, though with
great difficulty. In about ten minutes she vomited: a kind of stupor,
occaisioned by the depression of the cranium, remained for some days, but
proper means being used, the child was restored to perfect health and spirits
in about a week.
"Mr. Squires gave this astonishing case of recovery to the above gentlemen,
from no other motive than a desire of promoting the good of mankind; and
hopes for the future that no person will be given up for dead, till various
means have been used for their recovery."
Since it is clear she sustained a head injury the electricity probably
stimulated the child out of deep coma rather than providing cardiac
defibrillation (see also 1788, Charles Kite). Annual Report 1774: Humane
Society, London. pp 31-32

1775

1786

Abildgaard shows that hens can be made lifeless with electrical impulses and
he could restore a pulse with electrical shocks across the chest. "With a
shock to the head, the animal was rendered lifeless, and arose with a second
shock to the chest; however, after the experiment was repeated rather
often, the hen was completely stunned, walked with some difficulty, and did
not eat for a day and night; then later it was very well and even laid an
egg." Abildgaard, Peter Christian. Tentamina electrica in animalibus. Inst
Soc Med Havn. 1775; 2:157-61.
Italian Anatomist Luigi Galvani notes that a dissected frog's leg
twitches when touched with a metal scalpel. He had been
studying the effects of electricity on animal tissues that
summer.

Luigi Galvani

On 20th September 1786 he wrote "I had dissected and

prepared a frog in the usual way and while I was attending to
something else I laid it on a table on which stood an electrical
machine at some distance from its conductor and separated
from it by a considerable space. Now when one of the persons
present touched accidentally and lightly the inner crural nerves
of the frog with the point of a scalpel, all the muscles of the
legs seemed to contract again and again as if they were
affected by powerful cramps."
He later showed that direct contact with the electrical
generator or the ground through an electrical conductor would
lead to a muscle contraction. Galvani also used brass hooks
that attached to the frog's spinal cord and were suspended
from an iron railing in a part of his garden. He noticed that the
frogs' legs twitched during lightening storms and also when the
weather was fine. He interperated these results in terms of
"animal electricity" or the preservation in the animal of
"nerveo-electrical fluid" similar to that of an electric eel. He
later also showed that electrical stimulation of a frog's heart
leads to cardiac muscular contraction. Galvani. De viribus
Electritatis in motu musculari Commentarius. 1791
Galvani's name is given to the 'galvanometer' which is an
instrument for measuring (and recording) electricity - this is
essentially what an ECG is; a sensitive galvanometer.

1788

Charles Kite wins the Silver Medal of the Humane Society (awarded at the
first Prize Medal ceremony of the Society co-judged with the Medical Society
of London) with an essay on the use of electricity in the diagnosis and
resuscitation of persons apparently dead. This essay is often cited as the
first record of cardiac defibrillation but the use of electricity suggested by Mr
Kite is much different. For example, on describing a case of drowning from
1785 where resuscitation had been attempted with artificial respiration,
warmth, tobacco, "volatiles thrown into the stomach, frictions, and various
lesser stimuli" for nearly an hour, he then recalls the use of electricity.
"Electricity was then applied, and shocks sent through in every possible
direction; the muscles through which the fluid [electricity] passed were
thrown into strong contractions." He concluded that electricity was a
valuable tool that could determine whether or not a person, apparently
dead, could be successfully resuscitated. Annual Report 1788: Humane

1792

Society, London. pp 225-244. Kite C. An Essay on the Recovery of the

Apparently Dead. 1788: C. Dilly, London.

Alessandro Volta

1800 to
1895
1819

1820

1825

Alessandro Volta, Italian Scientist and inventor, attempts to

disprove Galvani's theory of "animal electricity'" by showing
that the electrical current is generated by the combination of
two dissimilar metals. His assertion was that the electrical
current came from the metals and not the animal tissues. (We
now know that both Galvani and Volta were right.) To prove his
theory he develops the voltaic pile in 1800 (a column of
alternating metal discs - zinc with copper or silver - separated
by paperboard soaked in saline) which can deliver a substantial
and steady current of electricity. Enthusiasm in the use of
electricity leads to further attempts at reanimation of the dead
with experiments on recently hanged criminals. Giovani Aldini
(the nephew of Galvani) conducts an experiment at the Royal
College of Surgeons in London in 1803. The executed criminal
had lain in a temperature of 30 F for one hour and was
transported to the College. "On applying the conductors to the
ear and to the rectum, such violent muscular contractions were
executed, as almost to give the appearance of the
reanimation". Aldini, J. Essai: Thorique et exprimental sur
le Galvanisme, Paris (1804), Giovani Aldini. General Views on
the Application of Galvanism to Medical Purposes Principally in
cases of suspended Animation (London: J. Callow, Princes
Street and Burgess and Hill, Great Windmill Street, 1819).
Mary Shelly's Frankenstein was published in 1818. Louis
Figuier, Les merveilles de la Science (Paris, 1867), p.653

The design of sensitive instruments that could detect the small

electrical currents in the heart.

While demonstrating to students the heating of a platinum wire with

electricity from a voltaic pile at the University of Copenhagen, Danish
physicist Hans Christian Oersted notices that a nearby magnetized compass
needle moves each time the electrical current is turned on. He discovers
electromagnetism which is given a theoretical basis (with remarkable speed)
by Andr Marie Ampre.
Johann (Johan) Schweigger of Nuremberg increases the movement of
magnetized needles in electromagnetic fields. He found that by wrapping the
electric wire into a coil of 100 turns the effect on the needle was multiplied.
He proposed that a magnetic field revolved around a wire carrying a current
which was later proven by Michael Faraday. Schweigger had invented the
first galvanometer and announced his discovery at the University of Halle on
16th September 1820.
Leopoldo Nobili, Professor of Physics at Florence, develops an 'astatic
galvanometer'. Using two identical magnetic needles of opposite polarity,
either fixed together with a figure of eight arrangment of wire loops (in
earlier versions), or one moveable needle with a wire loop and one with a
scale (in later versions), the effects of the earth's magnetic field could be
compensated for. In 1827, using this instrument, he managed to detect the
flow of current in the body of a frog from muscles to spinal cord. He
detected the electricity running along saline moistened cotton thread joining
the dissected frog's legs in one jar to its body in another jar. Nobili was

1838

working to support the theory of animal electricity and this conduction,

transmitted without wires, he felt demonstrated animal electricity.

Carlo Matteucci

1840

Carlo Matteucci, Professor of Physics at the University of Pisa,

and student of Nobili, shows that an electric current
accompanies each heart beat. He used a preparation known as
a 'rheoscopic frog' in which the cut nerve of a frog's leg was
used as the electical sensor and twitching of the muscle was
used as the visual sign of electrical activity. He also used
Nobili's astatic galvanometer for the study of electricity in
muscles typically inserting one galvanometer wire in the open
end of the dissected muscle and the other on the surface of the
muscle. He went on to try and demonstrate conduction in
nerve but was unable to do so (since his galvanometers were
not sensitive enough). Matteucci C. Sur un phenomene
physiologique produit par les muscles en contraction. Ann
Chim Phys 1842;6:339-341

Dr Golding Bird, a Physician, accomplished chemist and member of the

London Electrical Society, opens an electrical therapy room at Guy's
Hospital, London treating a large range of diseases. Although the application
of electricity was popular it was not considered a subject worthy of serious
investigation. Because of Bird's reputation as a researcher electrical therapy
achieved popularity amongst London Physicians including his mentor Dr
Thomas Addison. Bird G. Lectures on Electricity and Galvanism, in their
physiological and therapeutical relations, delivered at the Royal College of
Physicians, in March, 1847 (Wilson & Ogilvy, London, 1847)

1843

Emil Du bois-Reymond

1849

1850

1856

German physiologist Emil Du bois-Reymond describes an

"action potential" accompanying each muscular contraction. He
detected the small voltage potential present in resting muscle
and noted that this diminished with contraction of the muscle.
To accomplish this he had developed one of the most sensitive
galvanometers of his time. His device had a wire coil with over
24,000 turns - 5 km of wire. Du Bios Reymond devised a
notation for his galvanometer which he called the 'disturbance
curve'. "o" was the stable equilibrium point of the astatic
galvanometer needle and p, q, r and s (and also k and h) were
other points in its deflection. Du Bois-Reymond, E.
Untersuchungen uber thierische Elektricitat. Reimer, Berlin:
1848.

H. Bence Jones, Physician at St George's Hospital, reports on the

disappointing results of electrical therapy on his patients. He concluded that
only four of his 23 cases seemed to improve. H. Bence Jones. Remedial
Action of Electricity. Lond J Med Feb 1849; s2-1: 125 - 129;
doi:10.1136/bmj.s2-1.2.125
Bizarre unregulated actions of the ventricles (later called ventricular
fibrillation) is described by Hoffa during experiments with strong electrical
currents across the hearts of dogs and cats. He demonstrated that a single
electrical pulse can induce fibrillation. Hoffa M, Ludwig C. 1850. Einige neue
versuche uber herzbewegung. Zeitschrift Rationelle Medizin, 9: 107-144
Rudolph von Koelliker and Heinrich Muller confirm that an electrical current
accompanies each heart beat by applying a galvanometer to the base and
apex of an exposed ventricle. They also applied a nerve-muscle preparation,

similar to Matteucci's, to the ventricle and observed that a twitch of the

muscle occured just prior to ventricular systole and also a much smaller
twitch after systole. These twitches would later be recognised as caused by
the electrical currents of the QRS and T waves. von Koelliker A, Muller H.
Nachweis der negativen Schwankung des Muskelstroms am naturlich sich
kontrahierenden Herzen. Verhandlungen der Physikalisch-Medizinischen
Gesellschaft in Wurzberg. 1856;6:528-33.
1858

1867

William Thompson (Lord Kelvin), Professor of Natural Philosophy at Glasgow

University, invents the 'mirror galvanometer' for the reception of
transatlantic telegraph transmissions. A small, freely rotating mirror, with
magents stuck to its back is suspended in a fine copper coil and a reflected
spot of light from this mirror 'amplifies' the small movements when electrical
current is present. The whole apparatus was suspended in an air chamber
and the pressure inside could be adjusted to vary the damping seen on the
signals. This galvanometer was sensitive enough for transatlantic telegraphy.

Thompson improves telegraph transmissions with the 'Siphon Recorder'.

Before d'Arsonval (1880), Thompson uses a fine coil suspended in a strong
magnetic magnetic field. Attached to the coil but isolated from it by ebonite
(an insulator) was a siphon of ink. The siphon was charged with high voltage
so that the ink was sprayed onto the paper that moved over an earthed
metal surface. The siphon recorder could therefore not only detect currents
it could also record them onto paper.
1869-70
Alexander Muirhead, an electrical engineer and pioneer of telegraphy, may
have a recorded a human electrocardiogram at St Bartholomew's Hospital,
London but this is disputed. If he had he is thought to have used a
Thompson Siphon Recorder. Elizabeth Muirhead, his wife, wrote a book of his
life and claimed that he refrained from publishing his own work for fear of
misleading others. Elizabeth Muirhead. Alexander Muirhead 1848 - 1920.
Oxford, Blackwell: privately printed 1926.
1872
French physicist Gabriel Lippmann invents a capillary electrometer. It is a
thin glass tube with a column of mercury beneath sulphuric acid. The
mercury meniscus moves with varying electrical potential and is observed
through a microscope.
1872
Mr Green, a surgeon, publishes a paper on the resuscitation of a series of
patients who had suffered cardiac and / or respiratory arrest during
anaesthesia with chloroform. He uses a galvanic pile (battery) of 200 cells
generating 300 Volts which he applied to the patient as follows "One pole
should be applied to the neck and the other to the lower rib on the left side."
Green T. On death from chloroform: its prevention by galvanism. Br Med J
1872 1: 551-3. Although this has been reported as an example of
cardiorespiratory resuscitation it is unclear what the exact mechanism seems
to be. It is unlikely to be electric cardioversion or external pacing. It seems
to be another example of electrophrenic stimulation (See also Duchenne
1872).
1872
Guillaume Benjamin Amand Duchenne de Boulogne, pioneering
neurophysiologist, describes the resuscitation of a drowned girl
with electricity in the third edition of his textbook on the
medical uses of electricity. This episode has sometimes been
described as the first 'artificial pacemaker' but he used an
electrical current to induce electrophrenic rather than

An 'electric' smile.

myocardial stimulation. Duchenne GB. De l'electrisation

localisee et de son application a la pathologie et la
therapeutique par courants induits at par courants galvaniques
interrompus et continus. [Localised electricity and its
application to pathology and therapy by means of induced and
galvanic currents, interrupted and continuous] 3ed. Paris. JB
Bailliere et fils; 1872
1875

1876

1878

1880

1884

1887

1889

Richard Caton, a Liverpool Physician, presents to the British Medical

Association in July 1875 in Edinburgh. Using a Thompson 'mirror
galvanometer' in animals he shows it was possible to detect 'feeble currents
of varying direction ... when the electrodes are placed on two points of the
external surface, or one electrode on the grey matter and one on the surface
of the skull'. This is the first report of the EEG (or electroencephalogram).
Caton was exploring another Physician's hypothesis, John Hughlings
Jackson, who suggested in 1873 that epilepsy was due to excessive
electrical activity in the grey matter of the brain. Caton R: The electric
currents of the brain. Br Med J 1875; 2(765):278, Mumenthaler, Mattle Eds.
Neurology. 4th Edition. Stuttgart, Thieme: 2004.
Marey uses the electrometer to record the electrical activity of an exposed
frog's heart. Marey EJ. Des variations electriques des muscles et du couer
en particulier etudies au moyen de l'electrometre de M Lippman. Compres
Rendus Hebdomadaires des Seances de l'Acadamie des sciences
1876;82:975-977
British physiologists John Burden Sanderson and Frederick Page record the
heart's electrical current with a capillary electrometer and shows it consists
of two phases (later called QRS and T). Burdon Sanderson J. Experimental
results relating to the rhythmical and excitatory motions of the ventricle of
the frog. Proc R Soc Lond 1878;27:410-414
French physicist Arsne d'Arsonval in association with Marcel Deprez,
improves the galvanometer. Instead of a magnetized needle moving when
electrical current flows through a surrounding wire coil the Deprezd'Arsonval galvanometer has a fixed magnet and moveable coil. If a pointer
is attached to the coil it can move over a suitably calibrated scale. The
d'Arsonval galvanometer is the basis for most modern galvanometers.
Comptes rendus de l'Acadmie des sciences, 1882, 94: 1347-1350
John Burden Sanderson and Frederick Page publish some of their recordings.
Burdon Sanderson J, Page FJM. On the electrical phenomena of the
excitatory process in the heart of the tortoise, as investigated
photographically. J Physiol (London) 1884;4:327-338
British physiologist Augustus D. Waller of St Mary's Medical School, London
publishes the first human electrocardiogram. It is recorded with a capilliary
electrometer from Thomas Goswell, a technician in the laboratory. Waller
AD. A demonstration on man of electromotive changes accompanying the
heart's beat. J Physiol (London) 1887;8:229-234
Dutch physiologist Willem Einthoven sees Waller demonstrate his technique
at the First International Congress of Physiologists in Bale. Waller often
demonstrated by using his dog "Jimmy" who would patiently stand with
paws in glass jars of saline.

1889
Professor John McWilliam, of Aberdeen University, describes ventricular
fibrillation as "unexpected, and irretrievable cardiac failure [which] may ...
present itself in the form of an abrupt onset of fibrillar contraction ... The
cardiac pump is thrown out of gear, and the last of its vital energy is
dissipated in a violent and prolonged turmoil of fruitless activity in the
ventricular walls." He also describes the electrical stimulation of the heart in
cases of "fatal syncope" in man. "A single induction shock readily causes a
beat in an inhibited heart, and a regular series of induction shocks (for
example, sixty or seventy per minute) gives a regular series of heartbeats at
the same rate." McWilliam JA. Cardiac Failure and Sudden Death. Br Med J
1889;1:6-8. McWilliam JA. Electrical stimulation of the heart in man. Br Med
J 1889;1:34850.
1890

1891

GJ Burch of Oxford devises an arithmetical correction for the observed

(sluggish) fluctuations of the electrometer. This allows the true waveform to
be seen but only after tedious calculations. Burch GJ. On a method of
determining the value of rapid variations of a difference potential by means
of a capillary electrometer. Proc R Soc Lond (Biol) 1890;48:89-93
British physiologists William Bayliss and Edward Starling of University
College London improve the capillary electrometer. They connect the
terminals to the right hand and to the skin over the apex beat and show a
"triphasic variation accompanying (or rather preceding) each beat of the
heart". These deflections are later called P, QRS and T. Bayliss WM, Starling
EH. On the electrical variations of the heart in man. Proc Phys Soc (14th
November) in J Physiol (London) 1891;13:lviii-lix and also On the
electromotive phenomena of the mammalian heart. Proc R Soc Lond
1892;50:211-214 They also demonstrate a delay of about 0.13 seconds
between atrial stimulation and ventricular depolarisation (later called PR
interval). On the electromotive phenomena of the mammalian heart. Proc
Phys Soc (21st March) in J Physiol (London) 1891;12:xx-xxi

1893

Willem Einthoven introduces the term 'electrocardiogram' at a meeting of

the Dutch Medical Association. (Later he claims that Waller was first to use
the term). Einthoven W: Nieuwe methoden voor clinisch onderzoek [New
methods for clinical investigation]. Ned T Geneesk 29 II: 263-286, 1893

1895 to
date

The first accurate recording of the electrocardiogram and its

development as a clinical tool.

1895
Einthoven, using an improved electrometer and a correction formula
developed independently of Burch, distinguishes five deflections which he
names P, Q, R, S and T. Einthoven W. Ueber die Form des menschlichen
Electrocardiogramms. Arch f d Ges Physiol 1895;60:101-123
Why PQRST and not ABCDE? The four deflections prior to the correction
formula were labelled ABCD and the 5 derived deflections were labelled
PQRST. The choice of P is a mathematical convention dating from Descartes
(as used also by Du Bois-Reymond in his galvanometer's 'disturbance curve'
50 years previously) by using letters from the second half of the alphabet. N
has other meanings in mathematics and O is used for the origin of the
Cartesian coordinates. In fact Einthoven used O ..... X to mark the timeline
on his diagrams. P is simply the next letter. A lot of work had been
undertaken to reveal the true electrical waveform of the ECG by eliminating
the damping effect of the moving parts in the amplifiers and using correction
formulae. If you look at the diagram in Einthoven's 1895 paper you will see

how close it is to the string galvanometer recordings and the

electrocardiograms we see today. The image of the PQRST diagram may
have been striking enough to have been adopted by the researchers as a
true representation of the underlying form. It would have then been logical
to continue the same naming convention when the more advanced string
galvanometer started creating electrocardiograms a few years later. (For
more on Descartes see Henson JR. Descartes and the ECG lettering series. J
Hist Med Allied Sci. April 1971;181186)
1897

1899

Clement Ader, a French electrical engineer, reports his amplification system

for detecting Morse code signals transmitted along undersea telegraph lines.
It was never intended to be used as a galvanometer. Einthoven later quoted
Ader's work but seems to have developed his own amplification device
independently. Ader C. Sur un nouvel appareil enregistreur pour cables
sous-marins. C R Acad Sci (Paris) 1897;124:1440-1442
Karel Frederik Wenckebach publishes a paper "On the analysis
of irregular pulses" describing impairment of AV conduction
leading to progressive lengthening and blockage of AV
conduction in frogs. This will later be called Wenckebach block
(Mobitz type I) or Wenckebach phenomenon.

Karel Wenkebach

1899

Jean-Louis Prevost, Professor of Biochemistry, and Frederic Batelli, Professor

of Physiology, both of Geneva discover that large electrical voltages applied
across an animal's heart can stop ventricular fibrillation. Prevost JL, Batelli
F. Sur quelques effets des descharges electriques sur le coeur des
mammiferes. [On the effects of electric shocks on the hearts of mammals.]
Acad. Sci. Paris, FR.: 1899; 129:1267-1268.. They also report that
ventricular fibrillation can be induced by small voltages (40 V). Prevost JL,
Batelli F. La Mort Par Les Descharges Electriques. [Death by electrical
disharges]. Journ. de Physiol. 1899;1:1085-99.

top

1901

1902

1903

Einthoven invents a new galvanometer for producing electrocardiograms

using a fine quartz string coated in silver based on ideas by Deprez and
d'Arsonval (who used a wire coil). His "string galvanometer" weighs 600
pounds. Einthoven acknowledged the similar system by Ader but later
(1909) calculated that his galvanometer was in fact many thousands of
times more sensitive. Einthoven W. Un nouveau galvanometre. Arch Neerl
Sc Ex Nat 1901;6:625-633
Einthoven publishes the first electrocardiogram recorded on a string
galvanometer. Einthoven W. Galvanometrische registratie van het
menschilijk electrocardiogram. In: Herinneringsbundel Professor S. S.
Rosenstein. Leiden: Eduard Ijdo, 1902:101-107

Einthoven discusses commercial production of a string galvanometer with

Max Edelmann of Munich and Horace Darwin of Cambridge Scientific
Instruments Company of London.
1905

1905

1906

1906

Einthoven starts transmitting electrocardiograms from the hospital to his

laboratory 1.5 km away via telephone cables. On March 22nd the first
'telecardiogram' is recorded from a healthy and vigorous man and the tall R
waves are attributed to his cycling from laboratory to hospital for the
recording.
John Hay of Liverpool, publishes pressure recordings from a 65 year old man
showing heart block in which AV conduction did not seem to be impaired
since the a-c intervals on the jugular venous waves was unchanged in the
conducted beats. This is the first demonstration of what we now call Mobitz
type II AV block. Hay J. Bradycardia and cardiac arrhythmias produced by
depression of certain functions of the heart. Lancet 1906;1:138-143.
Einthoven publishes the first organised presentation of normal and abnormal
electrocardiograms recorded with a string galvanometer. Left and right
ventricular hypertrophy, left and right atrial hypertrophy, the U wave (for the
first time), notching of the QRS, ventricular premature beats, ventricular
bigeminy, atrial flutter and complete heart block are all described. Einthoven
W. Le telecardiogramme. Arch Int de Physiol 1906;4:132-164 (translated
into English. Am Heart J 1957;53:602-615)
Cremer records the first oesophageal electrocardiogram which he achieved
with the help of a professional sword swallower. Oesophageal
electrocardiography later developed in the 1970s to help differentiate atrial
arrhythmias. He also records the first fetal electrocardiogram from the
abdominal surface of a pregnant woman. Cremer. Ueber die direkte
Ableitung der Aktionstrme des menslichen Herzens vom Oesophagus und
ber das Elektrokardiogramm des Ftus. Munch. Med. Wochenschr.
1906;53:811

1907

1908
1909

Arthur Cushny, professor of pharmacology at University College London,

publishes the first case report of atrial fibrillation. His patient was 3 days
post-op following surgery on an "ovarian fibroid" when she developed a
"very irregular" pulse at a rate of 120 - 160 bpm. Her pulse was recorded
with a "Jacques sphygmochronograph" which shows the radial pulse
pressure against time - much like the arterial line blood pressure recordings
used in Intensive Care today. Cushny AR, Edmunds CW. Paroxysmal
irregularity of the heart and auricular fibrillation. Am J Med Sci
1907;133:66-77.
Edward Schafer of the University of Edinburgh is the first to buy a string
galvanometer for clinical use.
Thomas Lewis of University College Hospital, London buys a string
galvanometer and so does Alfred Cohn of Mt Sinae Hospital, New York.

1909

1910

Nicolai and Simmons report on the changes to the electrocardiogram during

angina pectoris. Nicolai DF, Simons A. (1909) Zur klinik des
elektrokardiogramms. Med Kiln 5;160
Walter James, Columbia University and Horatio Williams, Cornell University
Medical College, New York publish the first American review of
electrocardiography. It describes ventricular hypertrophy, atrial and

1911

ventricular ectopics, atrial fibrillation and ventricular fibrillation. The

recordings were sent from the wards to the electrocardiogram room by a
system of cables. There is a great picture of a patient having an
electrocardiogram recorded with the caption "The electrodes in use".James
WB, Williams HB. The electrocardiogram in clinical medicine. Am J Med Sci
1910;140:408-421, 644-669
Thomas Lewis publishes a classic textbook. The mechanism of the heart
beat. London: Shaw & Sons and dedicates it to Willem Einthoven.

1912

1912

1918

1920

Thomas Lewis publishes a paper in the BMJ detailing his careful clinical and
electrocardiographic observations of atrial fibrillation. Lewis describes how
he and a colleague, Dr Woordruff a vet, identified the condition in horses
and, at a later date, witnessed the fibrillating heart of a horse on Bulford
Plain. "The chest was opened while the heart was still beating, and I
obtained, as did those with me, a clear view of a fibrillating auricle, brought
to this state, not by experimental interference, but by disease." Lewis T. A
Lecture ON THE EVIDENCES OF AURICULAR FIBRILLATION, TREATED
HISTORICALLY: Delivered at University College Hospital. Br Med J
1912;1:57-60.
Einthoven addresses the Chelsea Clinical Society in London and describes an
equilateral triangle formed by his standard leads I, II and III later called
'Einthoven's triangle'. This is the first reference in an English article I have
seen to the abbreviation 'EKG'.Einthoven W. The different forms of the
human electrocardiogram and their signification. Lancet 1912(1):853-861
Bousfield describes the spontaneous changes in the electrocardiogram
during angina. Bousfield G. Angina pectoris: changes in electrocardiogram
during paroxysm. Lancet 1918;2:475
Hubert Mann of the Cardiographic Laboratory, Mount Sinai Hospital,
describes the derivation of a 'monocardiogram' later to be called
'vectorcardiogram'. Mann H. A method of analyzing the electrocardiogram.
Arch Int Med 1920;25:283-294

1920

1924
1924

1926

1928

Harold Pardee, New York, publishes the first electrocardiogram of an acute

myocardial infarction in a human and describes the T wave as being tall and
"starts from a point well up on the descent of the R wave". Pardee HEB. An
electrocardiographic sign of coronary artery obstruction. Arch Int Med
1920;26:244-257
Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.
Woldemar Mobitz publishes his classification of heart blocks (Mobitz type I
and type II) based on the electrocardiogram and jugular venous pulse
waveform findings in patients with second degree heart block. Mobitz W.
Uber die unvollstandige Storung der Erregungsuberleitung zwischen Vorhof
und Kammer des menschlichen Herzens. (Concerning partial block of
conduction between the atria and ventricles of the human heart). Z Ges Exp
Med 1924;41:180-237.
A doctor from the Crown Street Women's Hospital in Sydney, who wished to
remain anonymous, resuscitates a new-born baby with an electrical device
later called a 'pacemaker'. The doctor wanted to remain anoymous because
of the controversy surrounding research that artificially extended human life.

Ernstine and Levine report the use of vacuum-tubes to amplify the

electrocardiogram instead of the mechanical amplification of the string
galvanometer. Ernstine AC, Levine SA. A comparison of records taken with
the Einthoven string galvanomter and the amplifier-type electrocardiograph.
Am Heart J 1928;4:725-731
1928

1929

1930

Frank Sanborn's company (founded 1917 and acquired by Hewlett-Packard

in 1961 and since 1999, Philips Medical Systems) converts their table model
electrocardiogram machine into their first portable version weighing 50
pounds and powered by a 6-volt automobile battery.
Sydney doctor Mark Lidwill, physician, and Edgar Booth, physicist, report the
electrical resuscitation of the heart to a meeting in Sydney. Their portable
device uses an electrode on the skin and a transthoracic catheter. Edgar
Booth's design could deliver a variable voltage and rate and was employed
to deliver 16 volts to the ventricles of a stillborn infant. Lidwell M C, "Cardiac
Disease in Relation to Anaesthesia" in Transactions of the Third Session,
Australasian Medical Congress, Sydney, Australia, Sept. 2-7 1929, p 160.
Wolff, Parkinson and White report an electrocardiographic syndrome of short
PR interval, wide QRS and paroxysmal tachycardias. Wolff L, Parkinson J,
White PD. Bundle branch block with short P-R interval in healthy young
people prone to paroxysmal tachycardia. Am Heart J 1930;5:685. Later,
when other published case reports were examined for evidence of preexcitation, examples of 'Wolff Parkinson White' syndrome were identified
which had not been recognised as a clinical entity at the time. The earliest
example was published by Hoffmann in 1909. Von Knorre GH. The earliest
published electrocardiogram showing ventricular preexcitation. Pacing Clin
Electrophysiol. 2005 Mar;28(3):228-30

1930

1931

Sanders first describes infarction of the right ventricle. Sanders, A.O.

Coronary thrombosis with complete heart block and relative ventricular
tachycardia: a case report, American Heart Journal 1930;6:820-823.
Charles Wolferth and Francis Wood describe the use of exercise to provoke
attacks of angina pectoris. They investigated the ECG changes in normal
subjects and those with angina but dismissed the technique as too
dangerous "to induce anginal attacks indiscriminately". Wood FC, Wolferth
CC, Livezey MM. Angina pectoris. Archives Internal Medicine 1931;47:339

1931

first patented pacemaker

1932

Dr Albert Hyman patents the first 'artificial cardiac pacemaker'

which stimulates the heart by using a transthoracic needle. His
aim was to produce a device that was small enough to fit in a
doctor's bag and stimulate the right atrial area of the heart
with a suitably insulated needle. His experiments were on
animals. His original machine was powered by a crankshaft (it
was later prototyped by a German company but was never
successful). "By March 1, 1932 the artificial pacemaker had
been used about 43 times, with a successful outcome in 14
cases." It was not until 1942 that a report of its successful
short term use in Stokes-Adams attacks was presented.
Hyman AS. Resuscitation of the stopped heart by intracardial
therapy. Arch Intern Med. 1932;50:283

Goldhammer and Scherf propose the use of the electrocardiogram after

moderate exercise as an aid to the diagnosis of coronary insufficiency.

1932

1934

Goldhammer S, Scherf D. Elektrokardiographische untersuchungen bei

kranken mit angina pectoris. Z Klin Med 1932;122:134
Charles Wolferth and Francis Wood describe the clinical use of chest leads.
Wolferth CC, Wood FC. The electrocardiographic diagnosis of coronary
occlusion by the use of chest leads. Am J Med Sci 1932;183:30-35
By joining the wires from the right arm, left arm and left foot with 5000
Ohm resistors Frank Wilson defines an 'indifferent electrode' later called the
'Wilson Central Terminal'. The combined lead acts as an earth and is
attached to the negative terminal of the ECG. An electrode attached to the
positive terminal then becomes 'unipolar' and can be placed anywhere on
the body. Wilson defines the unipolar limb leads VR, VL and VF where 'V'
stands for voltage (the voltage seen at the site of the unipolar electrode).
Wilson NF, Johnston FE, Macleod AG, Barker PS. Electrocardiograms that
represent the potential variations of a single electrode. Am Heart J.
1934;9:447-458.

1935

1938

McGinn and White describe the changes to the electrocardiogram during

acute pulmonary embolism including the S1 Q3 T3 pattern. McGinn S, White
PD. Acute cor pulmonale resulting from pulmonary embolism: its clinical
recognition. JAMA 1935;114:1473.
American Heart Association and the Cardiac Society of Great Britain define
the standard positions, and wiring, of the chest leads V1 - V6. The 'V' stands
for voltage. Barnes AR, Pardee HEB, White PD. et al. Standardization of
precordial leads. Am Heart J 1938;15:235-239

1938

Tomaszewski notes changes to the electrocardiogram in a man who died of

hypothermia. Tomaszewski W. Changements electrocardiographiques
observes chez un homme mort de froid. Arch Mal Coeur 1938;31:525.

top

1939

1942

1942

Langendorf reports a case of atrial infarction discovered at autopsy which, in

retrospect, could have been diagnosed by changes on the ECG. Langendorf
R. Elektrokardiogramm bei Vorhof-Infarkt. Acta Med Scand. 1939;100:136.
Emanuel Goldberger increases the voltage of Wilson's unipolar leads by 50%
and creates the augmented limb leads aVR, aVL and aVF. When added to
Einthoven's three limb leads and the six chest leads we arrive at the 12-lead
electrocardiogram that is used today.
Arthur Master, standardises the two step exercise test (now known as the
Master two-step) for cardiac function. Master AM, Friedman R, Dack S. The
electrocardiogram after standard exercise as a functional test of the heart.
Am Heart J. 1942;24:777

1944

1947

Young and Koenig report deviation of the P-R segment in a series of patients
with atrial infarction. Young EW, Koenig BS. Auricular infarction. Am Heart J.
1944;28:287.
Gouaux and Ashman describe an observation that helps differentiate
aberrant conduction from ventricular tachycardia. The 'Ashman
phenomenon' occurs when a stimulus falls during the relative or absolute
refractory period of the ventricles and the aberrancy is more pronounced. In

atrial fibrillation with aberrant conduction this is demonstrated when the

broader complexes are seen terminating a relatively short cycle that follows
a relatively long one. The QRS terminating the shorter cycle is conducted
'more aberrantly' because it falls in the refractory period. The aberrancy is
usually of a RBBB pattern. Gouaux JL, Ashman R. Auricular fibrillation with
aberration simulating ventricular paroxysmal tachycardia. Am Heart J
1947;34:366-73.
1947

1948

Claude Beck, a pioneering cardiovascular surgeon in Cleveland, successfully

defibrillates a human heart during cardiac surgery. The patient is a 14 year
old boy - 6 other patients had failed to respond to the defibrillator. His
prototype defibrillator followed experiments on defibrillation in animals
performed by Carl J. Wiggers, Professor of Physiology at the Western
Reserve University. Beck CS, Pritchard WH, Feil SA: Ventricular fibrillation of
long duration abolished by electric shock. JAMA 1947; 135: 985-989.
Wiggers CJ, Wegria R. Ventricular fibrillation due to single localized induction
in condenser shock supplied during the vulnerable phase of ventricular
systole. Am J Physiol 1939;128:500
Rune Elmqvist, Swedish engineer who had trained as a doctor but never
practiced, introduces the first ink jet printer for the transcription of analog
physiological signals. He demonstrates its use in the recording of ECGs at
the First International Congress of Cardiology in Paris in 1950. The machine
(the mingograph) was developed by him at the company that later became
Siemens. (Luderitz, 2002)

1949
Montana physician Norman Jeff Holter develops a 75 pound
backpack that can record the ECG of the wearer and transmit
the signal. His system, the Holter Monitor, is later greatly
reduced in size, combined with tape / digital recording and
used to record ambulatory ECGs. Holter NJ, Generelli JA.
Remote recording of physiologic data by radio. Rocky Mountain
Med J. 1949;747-751.
modern 'Holter' Monitor

1949

1950

1953

Sokolow and Lyon propose diagnostic criteria for left ventricular hypertrophy
i.e. LVH is present if the sum of the size of the S wave in V1 plus the R wave
in V6 exceeds 35 mm. Sokolow M, Lyon TP. The ventricular complex in left
ventricular hypertrophy as obtained by unipolar precordial and limb leads.
Am Heart J 1949;37:161
John Hopps, a Canadian electrical engineer and researcher for the National
Research Council, together with two physicians (Wilfred Bigelow, MD of the
University of Toronto and his trainee, John C. Callaghan, MD) show that a
coordinated heart muscle contraction can be stimulated by an electrical
impulse delivered to the sino-atrial node. The apparatus, the first cardiac
pacemaker, measures 30cm, runs on vacuum tubes and is powered by
household 60Hz electrical current. Bigelow WG, Callaghan JC, Hopps JA.
"General hypothermia for experimental intracardiac surgery." Ann Surg
1950; 1132: 531-539.
Osborn, whilst experimenting with hypothermic dogs, describes the
prominent J (junctional) wave which has often been known as the "Osborn
wave". He found the dogs were more likely to survive if they had an infusion
of bicarbonate and supposed the J wave was due to an injury current caused
by acidosis. Osborn JJ. Experimental hypothermia: respiratory and blood pH
changes in relation to cardiac function. Am J Physiol 1953;175:389.

1955

1956

Richard Langendorf publishes the "rule of bigeminy" whereby ventricular

bigeminy tends to perpetuate itself. Langendorf R, Pick A, Winternitz M.
Mechanisms of intermittent ventricular bigeminy. I. Appearence of ectopic
beats dependent upon the length of the ventricular cycle, the "rule of
bigeminy." circulation 1955;11:442.
Paul Zoll, a cardiologist, uses a more powerful defibrillator and performs
closed-chest defibrillation in a human. Zoll PM, Linenthal AJ, Gibson P:
Termination of Ventricular Fibrillation in Man by Externally Applied
Countershock . NEJM 1956; 254: 727-729

1957
Anton Jervell and Fred Lange-Nielsen of Oslo describe an
autosomal recessive syndrome of long-QT interval, deafness
and sudden death later known as the Jervell-Lange-Nielsen
syndrome. Jervell A, Lange-Nielsen F. Congenital deaf mutism,
functional heart disease with prolongation of the QT interval
and sudden death. Am Heart J 1957;54:59.
long QT syndrome

1958

1959

Professor Ake Senning, of Sweden, places the first implantable cardiac

pacemaker designed by Rune Elmqvist into a 43-year-old patient with
complete heart block and syncope (Arne Larsson).
Myron Prinzmetal describes a variant form of angina in which the ST
segment is elevated rather than depressed. Prinzmetal M, Kennamer R,
Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina
pectoris. Am J Med 1959;27:374.

1960

1963

1963

Smirk and Palmer highlight the risk of sudden death from ventricular
fibrillation particularly when ventricular premature beats occur at the same
time as the T wave. The 'R on T' phenomenon. Smirk FH, Palmer DG. A
myocardial syndrome, with particular reference to the occurrence of sudden
death and of premature systoles interrupting antecedent T waves. Am J
Cardiol 1960;6:620.
Italian paediatrician C. Romano and Irish paediatrician O. Conor Ward (the
following year) independently report an autosomal dominant syndrome of
long-QT interval later known as the Romano-Ward syndrome. Romano C,
Gemme G, Pongiglione R. Aritmie cardiache rare dell'eta pediatrica. Clin
Pediatr. 1963;45:656-83.
Ward OC. New familial cardiac syndrome in children. J Irish Med Assoc.
1964;54:103-6

Excercise ECG

1963

Robert Bruce and colleages describe their multistage treadmill

exercise test later known as the Bruce Protocol. "You would
never buy a used car without taking it out for a drive and
seeing how the engine performed while it was running," Bruce
says, "and the same is true for evaluating the function of the
heart." Bruce RA, Blackman JR, Jones JW, Srait G. Exercise
testing in adult normal subjects and cardiac patients.
Pediatrics 1963;32:742
Bruce RA, McDonough JR. Stress testing in screening for
cardiovascular disease. Bull. N.Y. Acad Med. 1969;45:1288

1966

Baule and McFee are the first to detect the magnetocardiogram which is the
electromagnetic field produced by the electrical activity of the heart. It is a
method that can detect the ECG without the use of skin electrodes. Although
potentially a useful technique it has never gained clinical acceptance, partly
because of its greater expense. Baule GM, McFee R. Detection of the
magnetic field of the heart. Am Heart J. 1963;66:95-96.
Mason and Likar modify the 12-lead ECG system for use during exercise
testing. The right arm electrode is placed at a point in the infraclavicular
fossa medial to the border of the deltoid muscle, 2 cm below the lower
border of the clavicle. The left arm electrode is placed similarly on the left
side. The left leg electrode is placed at the left iliac crest. Although this
system reduces the variability in the ECG recording during exercise it is not
exactly equivalent to the standard lead positions. The Mason-Likar lead
system tends to distort the ECG with a rightward QRS axis shift, a reduction
in R wave amplitude in lead I and aVL, and a significant increase in R wave
amplitude in leads II, III and aVF. Eur Heart J. 1987 Jul;8(7):725-33

1966
Torsade de pointes

1968

1968
1969

1974

Franois Dessertenne of Paris publishes the first case of

'Torsade de pointes' Ventricular Tachycardia. Dessertenne F. La
tachycardie ventriculaire a deux foyers opposes variables. Arch
des Mal du Coeur 1966; 59:263

Journal of Electrocardiography, the Official Journal of the International

Society for Computerized Electrocardiology and the International Society of
Electrocardiology, is founded by Zao and Lepeschkin.
Henry Marriott introduces the Modified Chest Lead 1 (MCL1) for monitoring
patients in Coronary Care.
Rosenbaum reviews the classification of ventricular premature beats and
adds a benign form that arises from the right ventricle and is not associated
with heart disease. This becomes known as the 'Rosenbaum ventricular
extrasystole'. Rosenbaum MB. Classification of ventricular extrasystoles
according to form. J Electrocardiol 1969;2:289.
Jay Cohn, of University of Minnesota Medical School, describes the
'syndrome of right ventricular dysfunction in the setting of acute inferior wall
myocardial infarction'. Cohn JN, Guiha NH, Broder MI. Right ventricular
infarction. Am J Cardiol 1974:33:209-214

1974

1976

1978

Gozensky and Thorne introduce the term 'Rabbit ears' to

electrocardiography. Rabbit ears describe the appearence of the QRS
complex in lead V1 with an rSR' pattern (good rabbit) being typical of Right
Bundle Branch Block and an RSr' (bad rabbit) suggesting a ventricular origin
i.e. ventricular ectopy / tachycardia. Gozensky C, Thorne D. Rabbit ears: an
aid in distinguishing ventricular ectopy from aberration. Heart Lung
1974;3:634.
Erhardt and colleagues describe the use of a right-sided precordial lead in
the diagnosis of right ventricular infarction which had previously been
thought to be electrocardiographically silent. Erhardt LR, Sjogrn A, Wahlberg
I. Single right-sided precordial lead in the diagnosis of right ventricular
involvement in inferior myocardial infarction. Am Heart J 1976;91:571-6
Dr Mieczyslaw (Michael) Mirowski and others file a US Patent "Circuit for
monitoring a heart and for effecting cardioversion of a needy heart"

1988

1992

(#4184493) which employs a transistor circuit that analyses the ECG signal
using a probability density function. This allows an implantable defibrillator
to detect when heart rhythm changes from normal (with steep QRS slopes)
to abnormal ventriclar fibrillation. This development of machineinterpretation of the ECG is essential for the safe deployment of an
automated defibrillator system and is reported in Circulation. Mirowski M,
Mower MM, Langer A, Heilman MS, Schreibman J. A chronically implanted
system for automatic defibrillation in active conscious dogs. Experimental
model for treatment of sudden death from ventricular fibrillation. Circulation
1978;58:90-94.
Professor John Pope Boineau of Washington University School of Medicine
publishes a 30-year percpective on the modern history of
electrocardiography. Boineau JP. Electrocardiology: A 30-year Perspective.
Ah Serendipity, My Fulsome Friend. Journal of Electrocardiology 21. Suppl
(1988): S1-9

Brugada syndrome

1992

1993

Cohen and He describe a new non-invasive approach to accurately map

cardiac electrical activity by using the surface Laplacian map of the body
surface electrical potentials. He B, Cohen RJ. Body surface Laplacian ECG
mapping. IEEE Trans Biomed Eng 1992;39(11):1179-91

Mac 5000, 15-lead ECG

1999

2000

Pedro Brugada and Josep brugada of Barcelona publish a series

of 8 cases of sudden death, Right Bundle Branch Block pattern
and ST elevation in V1 - V3 in apparently healthy individuals.
This 'Brugada Syndrome' may account for 4-12% of
unexpected sudden deaths and is the commonest cause of
sudden cardiac death in individuals aged under 50 years in
South Asia. The technology of the electrocardiogam, which is
over 100 years old, can still be used to discover new clinical
entities in cardiology. Brugada P, Brugada J. Right Bundle
Branch Block, Persistent ST Segment Elevation and Sudden
Cardiac Death: A Distinct Clinical and Electrocardiographic
Syndrome. J Am Coll Cardiol 1992;20:1391-6

Robert Zalenski, Professor of Emergency Medicine, Wayne

State University Detroit, and colleagues publish an influential
article on the clinical use of the 15-lead ECG which routinely
uses V4R, V8 and V9 in the diagnosis of acute coronary
syndromes. Like the addition of the 6 standardised unipolar
chest leads in 1938 these additional leads increase the
sensitivity of the electrocardiogram in detecting myocardial
infarction. Zalenski RJ, Cook D, Rydman R. Assessing the
diagnostic value of an ECG containing leads V4R, V8, and V9:
The 15-lead ECG. Ann Emerg Med 1993;22:786-793

Researchers from Texas show that 12-lead ECGs transmitted via wireless
technology to hand-held computers is feasible and can be interpreted
reliably by cardiologists. Pettis KS, Savona MR, Leibrandt PN et al.
Evaluation of the efficacy of hand-held computer screens for cardiologists'
interpretations of 12-lead electrocardiograms. Am Heart J. 1999 Oct;138(4
Pt 1):765-70
Physicians from the Mayo Clinic describe a new hereditary form of Short QT
syndrome associated with syncope and sudden death that they discovered in
1999. Several genes have since been implicated. Gussak I, Brugada P,

2005

Brugada J, et al. Idiopathic short QT interval: a new clinical syndrome?

Cardiology. 2000;94(2):99-102
Danish cardiologists report the successful reduction in the time between
onset of chest pain and primary angioplasty when the ECG of patients is
transmitted wirelessly from ambulance to the cardiologist's handheld PDA
(Personal Digital Assistant). The clinician can make an immediate decision to
redirect patients to the catheter lab saving time in transfers between
hospital departments. Clemmensen P, Sejersten M, Sillesen M et al.
Diversion of ST-elevation myocardial infarction patients for primary
angioplasty based on wireless prehospital 12-lead electrocardiographic
transmission directly to the cardiologist's handheld computer: a progress
report. J Electrocardiol. 2005 Oct;38(4 Suppl):194-8