From rebellious palpitations to the discovery of auricular fibrillation: contributions of Mackenzie, Lewis and Einthoven.

An irregular pulse, referred to as rebellious palpitations, delirium cordis and pulsus irregularis perpetuus, was a cause of speculation by physicians since early times. It was James Mackenzie, a Scottish general practitioner in Burnley, England, utilizing an ink-writing polygraph to record and label jugular venous pulses, who would pioneer in deciphering normal and abnormal cardiac rhythms. His key observation that the jugular "A wave" was lost in a patient who went from a normal to an irregular rhythm provided the first insight into the mechanism of auricular fibrillation. Similar jugular venous and arterial pulse findings were discovered by Cushny, Edmunds and Lewis in directly observed experimental auricular fibrillation. In 1909 Lewis in England and Rothberger and Winterberg in Vienna, taking advantage of Einthoven's newly developed string galvanometer, were the first to establish electrocardiographically that auricular fibrillation was the cause of pulsus irregularis perpetuus.