Cardiac Physiology (1953-55)

Dr. Starzl’s second foray into laboratory research took place after his first year of surgical training at Johns Hopkins, one of the hand full of hospitals where the development of open heart surgery was underway. One of the dread complications of the new operations was damage to the cardiac conduction system that resulted in a dangerous slowing or complete stoppage of the heart beat (heart block). Dr. Starzl discontinued all patient care duties for 18 months beginning in June, 1953, to study the adverse physiologic consequences of this complication and then how to reverse them. Because there had never been a reliable experimental model of heart block, the first step was to develop a procedure in dogs (Figure 1), and determine its effect on heart functions. A second requirement was the development of a canine treadmill (Figure 2) with which to determine the effect of exercise on the deranged heart. The ultimate objective was to devise a method of treatment and accurately delineate its effectiveness.

Dr. Starzl’s study showed that low voltage stimulation at any location on the lower chambers of the heart (the ventricles) was safe and efficient. This cardiac pacemaking was then instituted for the first time for patients at Hopkins and elsewhere. The 3 articles in the journal Circulation describing his experimental work [refs 1-3] each generated numerous citations [ref 4]. Using the same principles, pacing was soon instituted in patients whose heart block was caused by coronary artery disease or other non-surgical causes. Miniaturized implantable electrical pacemaking and other highly sophisticated variations of this method of treatment are part of today’s armamentarium against heart disease. Having accurately delineated the features and the treatment of heart block, Dr. Starzl turned his back on cardiac physiology as abruptly and completely as his departure from neuroscience. Figure 3 and Figure 4 show that these papers continued to be cited approximately 60 years after publication. However, having accurately delineated the features and the treatment of heart block, Dr. Starzl turned his back on cardiac physiology as abruptly and completely as his departure from neuroscience. Th citation frequency of these papers is also presented as a heat map in Figure 5.

References

Starzl TE, Gaertner RA, Webb RC Jr: The effects of repetitive electric cardiac stimulation in dogs with normal hearts, complete heart block and experimental cardiac arrest. Circulation 11:952-962, 1955.
https://d-scholarship.pitt.edu/3395/
Starzl TE, Gaertner RA, Baker RR: Acute complete heart block in dogs. Circulation 12:82-89, 1955.
https://d-scholarship.pitt.edu/3396/
Starzl TE, Gaertner RA: Chronic heart block in dogs. A method for producing experimental heart failure. Circulation 12:259-270, 1955.
https://d-scholarship.pitt.edu/3397/
See Cardiac Physiology Appendix for complete references and rank order citations

Appendix

Cardiac Physiology Bibliography and Citations

Figure 1

One of the detailed visual depictions that characterized many of Dr. Starzl's publications, this one on how to surgically produce heart block

Figure 2

The treadmill Dr. Starzl and his colleagues invented for the heart

Figure 3

Citation frequencies of articles referenced in this Discussion (1955-2011).

Figure 4

Annual citation frequencies of all publications related to theme of cardiac physiology (1955-2011).

Figure 5

Heat map showing annual citation frequencies of individual Cardiac Physiology publications.