A Shocking Experience

The discovery of defibrillation in 1899 by Prevost and Battelli1 has left us one of the most exciting clinical and research puzzles of the 20th century despite the obvious success of this treatment for arrhythmias. Initially, the idea of arresting ventricular fibrillation by the application of electric shock had seemed too fantastic even for Wiggers et al,2 whose research at Western Reserve University had laid the foundation for the first clinical application of defibrillation by Beck et al.3 During the last 2 decades of the 20th century, we witnessed clinical recognition and widespread application of implantable cardioverter-defibrillators (ICDs), which were stimulated in part by growing concern regarding the potentially harmful effects of antiarrhythmic drugs.4 Yet compelling evidence has been presented that pharmacological therapy combined with ICD therapy could decrease the frequency of shocks and improve the quality of life.5 Unfortunately, a lack of understanding of the ionic mechanisms of defibrillation impedes formulation of basic pharmacological strategies of defibrillation and redefinition of the role of antiarrhythmic drugs.4 The study by Cheek et al6 in this issue of Circulation Research presents one of the first attempts to build the basic science bridge between pharmacological and nonpharmacological therapies to control arrhythmias.Many investigators during the 20th century were puzzled by the mechanisms of defibrillation. Unfortunately, the inability of existing …