Introductory Note to a Classic Article by Carl J. Wiggers

The investigation of ventricular fibrillation began in the mid‐1800s when Hoffa and Ludwig documented the induction of ventricular fibrillation by an electrical stimulus in animals. ¹ At that time, spontaneous irregular contraction of the heart muscle (ventricular fibrillation) was thought to be due to abnormal electrical activity within the nerve fiber network of the heart. The Swiss physiologist Vulpian was the first to suggest a myogenic cause for fibrillation, and he is the one who coined the term “fibrillation” (mouvement fibrillaire). ² In 1899, Prevost and Batelli from Geneva, Switzerland discovered that while a weak faradic stimulus could produce ventricular fibrillation, a stronger stimulus could stop ventricular fibrillation and allow the return of normal sinus rhythm. Unfortunately, this discovery did not get much attention.

Dr. Carl Wiggers from Western Reserve University in Cleveland, Ohio expanded on the work of Prevost and Batelli. In the 1930s, Wiggers reported the induction of ventricular fibrillation by faradic stimulation, with abolition of the fibrillation by intracardiac injection of KCl followed by injection of CaCl₂ and supplementary cardiac massage. Wiggers also developed and perfected an electrical defibrillator for his animal studies. Dr. Claude Beck, a thoracic surgeon at Western Reserve University in Cleveland, was well aware of Wiggers' work, and in 1947 Dr. Beck successfully applied electrical defibrillation to save a child who developed ventricular fibrillation during a thoracic operation. ³ This life‐saving success with intraoperative defibrillation led to its immediate acceptance throughout the world and to the subsequent development of external and implantable defibrillators.

Dr. Wiggers made substantial contributions to cardiovascular physiology including fundamental investigations into circulatory dynamics, shock, arrhythmias, and virtually every physiologic function of the heart and blood vessels. Of the many articles that he wrote, I have chosen his classic article describing the fibrillatory process. ⁴ He was the first to combine cinematographic and electrocardiographic recordings of contractile and electrical phenomena in the study of ventricular fibrillation, from its onset to the late quiescent period many minutes later. He divided ventricular fibrillation into four phases and identified the early period (phase I or II) when fibrillation could be terminated. In subsequent studies, he showed that manual rhythmic compression of the heart (cardiac massage) during ventricular fibrillation reversed the electrical and mechanical fibrillatory deterioration and increased the likelihood of successful defibrillation with an electrical countershock. In brief, Wiggers provided the foundation for the life‐saving approach of combined external cardiac massage and countershock defibrillation that was introduced into clinical medicine in the early 1960s.