Summary Summary Leo Schamroth — was one of the best-known South Africans in the international medical community. His book, An Introduction to Electrocardiography, first published in , was my introduction to the mysteries of the ECG. The first edition was only 90 pages and was a model of clarity and simplicity, with remarkable insight into the needs of a student new to the subject. It has been translated into Spanish, Italian, Greek, Turkish and Japanese, and is said to be the book most often stolen from medical libraries worldwide. As a lecturer who combined unrivalled clarity with showmanship, he held his audiences, at home and all over the world, spellbound.
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Summary Summary Leo Schamroth — was one of the best-known South Africans in the international medical community. His book, An Introduction to Electrocardiography, first published in , was my introduction to the mysteries of the ECG. The first edition was only 90 pages and was a model of clarity and simplicity, with remarkable insight into the needs of a student new to the subject. It has been translated into Spanish, Italian, Greek, Turkish and Japanese, and is said to be the book most often stolen from medical libraries worldwide.
As a lecturer who combined unrivalled clarity with showmanship, he held his audiences, at home and all over the world, spellbound.
However, it was his ability to wring insights from the most ordinary-appearing ECG, by painstaking analysis, that is his enduring legacy. Written legacy In addition to eight books, he published over articles, many of which were co-authored by junior doctors, who were presented with the opportunity of a virtually guaranteed publication.
He wrote on all aspects of the ECG, bringing his unique combination of observation, analysis and clarity of exposition. This book introduced generations of undergraduate and postgraduate students to the intimidating mysteries of the ECG, explaining this with the aid of simple illustrations and ladder diagrams.
It was probably the most popular introduction to the ECG throughout the world. His magnum opus, The 12 Lead Electrocardiogram, was published posthumously. Although his books are out of print, they are still in demand and are available through various internet providers, at relatively high prices. Arrhythmias The Disorders of Cardiac Rhythm was enthusiastically received on its publication in Here he covered arrhythmias, on which he had been writing for years, with information on mechanisms and treatment, together with detailed discussion on illustrative cases.
Sinus node dysfunction: Among other publications on sinus node function, is an elegant article on the recognition and features of Wenckebach sino-atrial block. The clue to the Wenckebach mechanism is that the P—P interval shortens before the missing P wave, just as the R—R interval shortens before the dropped beat in the Wenckebach atrio-ventricular block. This is due to the fact that, while the P—R interval continues to lengthen, the increment diminishes.
The contribution of the P—R interval is therefore greatest for the first R—R interval of the sequence, and lessens thereafter. Bundle branch block and phasic aberrant ventricular conduction: Schamroth popularised the concept of phasic aberrant ventricular conduction, i.
The concept of incomplete left bundle branch block LBBB had been demonstrated experimentally, but not clinically, until the article by Schamroth and Bradlow. Because this occurred in the same patient and within a short time, it validated the existence and features of incomplete LBBB for the first time. In both of these articles, the mechanism of rate-related bundle branch block is clearly described and illustrated with diagrams.
Schamroth emphasised the importance of different refractory periods in the two bundle branches and the effects of changes in the R—R interval on His-Purkinje refractoriness. The apparent paradox of aberration occurring when a premature supraventricular complex follows a longer R—R interval, whereas conduction is normal at the same prematurity if the preceding R—R is shorter, is accounted for by the bundle branch refractory period shortening in response to the shorter R—R.
Atrioventricular AV conduction and heart block: Schamroth wrote articles on many aspects of atrio-ventricular conduction, including concealed conduction, the supernormal phase and Wedensky facilitation. Ventricular ectopy and parasystole: Schamroth was fascinated by ventricular ectopic rhythms.
He was adept at detecting the far-from-obvious relationships between apparently unrelated ventricular complexes. Ischaemic heart disease His books, articles and presentations covered all aspects of the subject, culminating in The Electrocardiology of Coronary Artery Disease.
One of his most memorable lectures was on the diagnosis of myocardial infarction in the presence of LBBB, which helped to debunk the myth that it could not be done.
It was, however, Leo Schamroth who was responsible for resuscitating his reputation and highlighting his singular contribution to the science of electrocardiology. It was a theatrical masterpiece, which received wide acclaim and resulted in Craib being elected to the Society of Scholars of Johns Hopkins University, which had failed to protect him when he was falsely accused of plagiarism and shunned by his peers.
If clubbing is present, the normal gap between the bases of the nails is filled in. He communicated his enthusiasm and flair for unearthing the hidden meaning in tracings to all who came in contact with him.
His influence extended worldwide through his books, articles and lectures and he elevated the ECG from a clinical tool to an intellectual delight. He built upon the traditions of the Chicago School of Electrocardiography and was in the same league as Richard Langendorf and Alfred Pick. While he did not ignore the clinical significance and context of his many observations, his focus was on the detailed analysis of timing and associations of ECG events to reveal relationships that were hidden from the casual observer.
He was slow to embrace the rapidly developing field of invasive cardiac electrophysiology, although it confirmed many of the brilliant deductions made by him and others, based on the surface ECG alone. Most notably, he was reluctant to accept the concept of reentry as the basis of most sustained ventricular tachycardias, preferring the concept of focal ectopic tachycardias. This was based on his calculations that ventricular conduction velocity and refractory periods largely precluded re-entry, although he conceded that bundle branch re-entry could occur.
Schamroth concentrated much of his intellectual effort on the intricacies of ventricular ectopy, parasystole and the rule of bigeminy. This work still stands as a monument to rigorous analysis, but its clinical significance is somewhat limited.
His clear exposition of the phenomenon of phasic aberrant ventricular conduction is as valid today as it was then. It nevertheless still causes confusion and is sometimes enthusiastically over diagnosed by those less skilled in ECG interpretation, resulting in misdiagnosis of ventricular tachycardia as supraventricular. Conclusion Leo Schamroth was a giant in the field of deductive electrocardiography and achieved international renown.
He was part of a fertile group whose remarkable deductive skills laid the basis for much of our current knowledge on the ECG. Modern electrophysiology, both clinical and experimental, has subsequently made huge strides, which have revolutionised our management of patients with cardiac arrhythmias and generated a large amount of information that has greatly improved our understanding of the lead ECG. References 1. Barold S. Biography of Leo Schamroth. Schamroth L, Dove E. The Wenckebach phenomenon in sino-atrial block.
Br Heart J. Schamroth L, Chesler E. Phasic aberrant ventricular conduction. Schamroth L, Bradlow BA. Incomplete left bundle branch block. Schamroth L. Genesis and evolution of ectopic ventricular rhythm. Personal experience.
S Afr Med J. Ventricular extrasystoles, ventricular tachycardia, and ventricular fibrillation: clinical-electrocardiographic considerations. Prog Cardiovasc Dis. Richard Langendorf: — — obituaries. Pacing Clin Electrophysiol.
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Leo Schamroth: his contributions to clinical electrocardiography
Part 5 Bradyarrhythmias and Related Diseases. Barcode Shelfmark Loan type Status This work still stands as a cshamroth to rigorous analysis, but its clinical significance is somewhat limited. Please apply exchange offer again. National Center for Biotechnology InformationU. Schamroth was fascinated by ventricular ectopic rhythms. This schamrotn an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Schamroth L, Bradlow BA.