Brief history of arrhythmia in the WPW syndrome - the contribution of George Ralph Mines

Abstract

George Ralph Mines studied the basic principles of reentry and published his data in The Journal of Physiology in 1913. Exactly 100 years later we discuss his first electrophysiological experiments and how his results lead to the insight that was the basis for the treatment of the clinical arrhythmias seen in Wolff-Parkinson-White syndrome.

Figure 1. George Ralph Mines

A photograph probably taken by Mrs Dorothy Thacker (at that time Dorothy Dale) at the Marine Biological Laboratory Plymouth, in the summer of 1911. In the same issue of this journal in which Mines paper ‘On the Dynamic Equilibrium in the Heart’ was published, there is also a paper by Dale and Mines on the influence of novel stimulation on the electrocardiogram. The late Professor David A. Rytand, of Stanford University, made this picture available to one of us (M.J.J.).

Figure 2

A schematic drawing of the tortoise preparation that Mines published in 1913 in his paper ‘On the Dynamic Equilibrium in the Heart’ (Mines, 1913).

Figure 3

Mines's diagram to explain that sustained reentry will occur in the presence of unidirectional block if conduction is slowed and the refractory period duration is decreased. A stimulated impulse leaves in its wake absolutely refractory tissue (black area) and relative refractory tissue (dotted area). In both A and B, the impulse conducts in one direction only. In A, because of fast conduction and a long refractory, the tissue is still absolutely refractory when the impulse has returned to its site of origin. In B, because of fast conduction and a long refractory period the tissue has recovered excitability by the time the impulse has reached the site of origin, and the impulse continues to circulate in the ring.(from Mines, 1913).

Figure 4

A, a section through the auriculo-ventricular junction at the right-hand margin of the heart that was published by Kent in 1913 (Kent, 1913). Note that this section does not show any structure crossing the plane of right-sided insulation. B, the electrocardiogram is shown of one of the patients from the study that Wolff, Parkinson and White published in 1930.(Wolff et al. 1930) C, left: a drawing that Wolferth made in 1933 in which he hypothesized that ‘premature transmission of the impulse through the bundle Kent to the right ventricle’ is the cause for the short PR interval. (Wolferth & Wood, 1933). C, right: the reentrant circuit during paroxysmal tachycardia is depicted, and is just as Mines described. D, a schematic picture giving the approximate position of the muscle bundle which was published in the thesis of Öhnell in 1944 ( Öhnell, 1944).