History of atrial fibrillation

There is hardly a symptom that has impressed patients and physicians since ancient times more than an irregular heartbeat. In most cases, atrial fibrillation is the cause of the rhythm disturbance. However, it took many centuries before we were able to clearly understand fibrillation and to counteract it efficiently. The history of arrhythmia therapy with drugs is long and fascinating. Digitalis was probably the first “antiarrhythmic”. It was discovered by Leonhart Fuchs in the 16th century and introduced in the clinical practice by William Withering from Birmingham. Today's rhythm agents are of a much later date. Quinidine, an optical isomer of quinine, became clinically available in 1918. Other antiarrhythmic drugs were only developed in the 60s and 70s of the previous century, e.g. disopyramide, beta-receptor blockers, propafenone, flecainide, amiodarone, adenosine, ibutilide, and dofetilide. Among the latest commercially available antiarrhythmic substances are dronedarone and vernakalant, which were clinically introduced in 2009 and 2010, respectively. Thanks to the further development of innovative pharmaceuticals and modern electrotherapeutic methods, it can be expected that the previously therapy-resistant cases of atrial fibrillation will be lastingly reduced.