Philip Liebson
Chicago, Illinois, United States

Sudden death from cardiac dysrhythmias is a frequent consequence of acute myocardial infarction. Before the 1960s, little could be done to prevent it, and patients were usually confined to bed for several weeks. Ventricular fibrillation, the underlying cause of sudden cardiac death, was a frequent occurrence.

In the 1950s, Dr. Paul Zoll developed a defibrillator attached to a wall plug, which allowed alternating current (AC) to be used to convert the cardiac rhythm to normal. However, Dr. Bernard Lown, a young investigator at the Peter Bent Brigham Hospital (now Brigham and Women’s) in Boston, found that AC could cause cardiac injuries and even lead to death.

Lown was one of the many Europeans who left for the United States in the 1930s to escape the threat of Nazism. At age fourteen, he moved with his family from Lithuania to Maine. Graduating from Johns Hopkins Medical School in 1945, he trained in cardiology at the Brigham under the mentorship of Dr. Samuel A. Levine, a leading specialist in the field.

At the time, patients with myocardial infarction were kept on strict bed rest for several weeks, which could lead to complications such as emboli and deconditioning and carried a mortality rate as high as 35%. Levine and Lown got patients up in a chair on the second day, much to the chagrin of other physicians, but effectively prevented complications and lowered mortality. Lown also noted the occasional complications of attempts at AC defibrillation. In the early 1960s, he conducted experiments using direct current (DC) cardioversion, which provides a shorter duration current that reversed ventricular fibrillation without causing skeletal burns or cardiac complications. DC cardioversion was also used for atrial and other ventricular dysrhythmias. A short electrical discharge was timed to be given outside of a vulnerable period of the electrocardiographic QT interval, which prevented ventricular fibrillation and converted the dysrhythmia to normal sinus rhythm.

The development of cardiac monitoring in coronary care units in the mid-1960s demonstrated the frequent occurrence of ventricular extrasystoles that led to ventricular fibrillation and often death. Lown experimented with lidocaine, an anesthetic agent used in dentistry, to suppress ventricular extrasystoles and demonstrated its success. At the time, nurses were not allowed to inject such medications, and the covering physicians might not have been available immediately for lidocaine injections or cardioversions. Lown and others realized that nurses could be just as competent in using lidocaine or even defibrillation. The success of coronary care units was in no small measure due to nurse participation in resuscitation.

In the early 1960s, when I was an intern, digitalis preparations included digoxin, digitoxin, squill, and other preparations, many of which led to digitalis poisoning. For example, blood levels of digitoxin were higher than digoxin since digitoxin has a longer half-life in the blood. Lown and others demonstrated that the use of short-acting digoxin and monitoring the potassium level were important in preventing digitalis toxic dysrhythmias. I distinctly remember the switch from digitoxin to digoxin when I was a cardiology trainee.

Besides working on coronary care, Lown also participated in an international physicians’ organization to prevent nuclear war and shared the Nobel Peace Prize for his efforts in 1985. He founded a foundation for cardiovascular research as well as an institute to help reform the healthcare system and society.

He died in 2021 at the age of ninety-nine. His death was due to heart failure.