Cardioversion: past, present, and future.

Simplicity is the ultimate sophistication. —Leonardo da Vinci R ecent years have seen rapid proliferation of ablative and antiarrhythmic therapies for treating various ventricular and supraventricular arrhythmias. Yet cardioversion and de-fibrillation remain the main modalities to restore normal sinus rhythm. Their simplicity, reliability, safety, and, most important , their efficacy in promptly restoring normal sinus rhythm are unmatched in our current treatment armamentarium. Contemporary cardiology has been significantly affected by the ready availability of this simple method for terminating atrial and ventricular tachyarrhythmias. However, fascination with electricity and its use in biological systems is hardly contemporary. The first capacitor that was able to store electric energy in a glass container was discovered in 1745. It was named the Leyden jar, and its use was shortly thereafter tested in the electrocution of small animals. There is a large body of literature in Italy, France, and England on biological and medical application of electricity dating from the 17th and 18th centuries. Although physicians across Europe started using electricity as an experimental treatment, the earliest recorded scientific approach with the use of electric shocks was that of Peter Abildgaard in 1775. 1 He systematically shocked hens, delivering electric charges in different parts of their body. Electric stimuli applied anywhere across the body of the hen, particularly in the head, could render the animal lifeless, but subsequent shocks delivered to the chest could revive the heart. Abildgaard was only one of the several scientists who studied the effects of electricity on animals. Some reported similar findings, and others could not reproduce his results. However, Luigi Galvani in 1781 first clearly described the link between electricity and its presence in biological systems. 2 He was the first to use the term animal electricity, coined after his famous experiments in which he caused the legs of a skinned frog to kick when touched with a pair of scissors during an electric storm. The recognition of electricity in living organisms sparked intense interest and excitement and led to application of electricity to revive the dead. Possibly the first description of successful resuscitation with the use of electric shock was reported by Charles Kite in 1788, when a 3-year-old girl, a victim of a fall, was shocked through the chest by an electric generator and a Leyden jar by a Mr Squires of London. 3 A similar report by Fell appeared in Gentlemen's Magazine in 1792, with the …