Rotors or Foci? Both!
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See Article by Panitchob et al
As to the fundamental mechanisms of fibrillation we have plenty of theories, but none is universally accepted… we may note in passing that they all center around two ideas … (a) that the impulses arise from centers or pacemakers, or (b) that the condition is caused by re-entry of impulses and the formation of circles of excitation. Each of these views, again, has two groups of exponents … (a) those who believe that a single focus, or excitation ring, occurs, and (b) those who favor the idea that multiple foci, or numerous circus rings, are developed.
—Carl J. Wiggers, 19401
Ventricular fibrillation (VF) was likely recognized as early as 3500 BCE when the Ebers Papyrus2 described key features of fibrillation as follows:
“If the heart trembles, has little power and sinks, the disease is advancing and death is near.”
The modern scientific effort to understand fibrillation did not begin until 1543, when Vesalius3 described worm-like movements in animal hearts during dissection just before they died. Erichsen4 in 1842 documented tumultuous, tremulous, and irregular behavior of ventricles consequent to coronary ligation. Hoffa and Ludwig5 first recorded VF using a kymograph (mechanical wave recorder) in 1850 (Figure, left). Interestingly, Hoffa, who was Ludwig’s pupil at the time, meant to stimulate neurons but accidentally stimulated the myocardium. They showed that irregular contractions of the ventricles could be induced by faradization (electric stimulation) and resulted in cardiac arrest that could not be checked by vagal stimulation. These studies of autonomic control of the heart suggested a neurogenic VF mechanism.