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Paul Zoll, MD: Originator of Modern Electrocardiac Therapy – A Biography by Stafford Cohen, MD, BIDMC

Reporter: Aviva Lev-Ari, PhD, RN

 

SOURCE

http://www.bidmc.org/Centers-and-Departments/Departments/Cardiovascular-Institute/CVI-Newsletter/StaffordCohen.aspx#sthash.lAe3b9Kk.dpuf

 

Paul Zoll: The Doctor Who Defied Sudden Cardiac Death

An Interview with Stafford Cohen, MD

 

Stafford Cohen, MD, a Beth Israel Deaconess Medical Center cardiologist who retired in 2009, retains the intellectual curiosity and the human touch that characterized his 48-year career in cardiology at Beth Israel Deaconess Medical Center. Over the years, Cohen had been intrigued by — and for a time shared an office with — Paul Zoll, MD, a brilliant yet controversial fellow cardiologist whose scientific work included numerous revolutionary breakthroughs that helped prevent sudden cardiac death.

Cohen, Honorary Senior Physician at the CardioVascular Institute, recently published a no-holds-barred biography, Paul Zoll, MD: The Pioneer Whose Discoveries Prevent Sudden Death. Heartmail recently spoke with Cohen about the man who made BIDMC an international center in the emerging field of cardiac electrophysiology, a position it retains today under the leadership of Mark E. Josephson, MD.

Why did you write this book?

Dr. Cohen: About six years ago, I started to reflect on my journey in cardiology — what I had done and what influenced me. I spent almost my entire career at Beth Israel Deaconess Medical Center.

I remember in medical school, I went to a lecture Dr. Paul Zoll gave and it was very exciting. My internship at the former Beth Israel Hospital (BIH) started in 1961 when he had completed his great contributions to using electrical stimulation to manage arrhythmias (abnormal beats) of the heart and people were being referred here from all over the world.

Paul was the first to develop a noninvasive, rapid way to use electrical treatment for life-threatening cardiac arrhythmias. He and his co-workers developed the science and I applied the science. My whole mission as a clinical cardiologist was to apply the science as perfectly as I could.

No one had ever written a biography about Zoll. I had the good fortune of knowing the core group who shared the same mission: to prevent sudden death. I wanted to honor him and preserve history, to add to his legacy, and to humanize him.

What were Dr. Zoll’s accomplishments?

Dr. Cohen: Paul Zoll was the father of modern electrocardiac therapy. The old way to treat cardiac arrest was to open the chest to pace or shock the heart with electric paddles. Another technique was to try to stimulate the heart by plunging a needle through the chest.

 

In 1952, Paul (at right, teaching) was the first to take a patient whose heart had stopped — he called him “Mr. A” — and jump-start it noninvasively with electric pacing by placing needles under the skin or electrodes on the surface of a closed chest.

In 1953, Paul and an associate, a biomedical engineer named Alan Belgard, developed the first alarmed heart monitor, a sentinel that would alert the hospital staff that the patient’s heart had stopped. The heart rate parameters could be adjusted.

In 1956, Paul delivered a high voltage shock to “Patient No. 3” through the chest to terminate ventricular fibrillation (a life-threatening irregular heartbeat). The instrument that has evolved from that is the AED (automated external defibrillator). His finger prints are all over the AED.

His contributions — the pacer, the defibrillator and the monitor — are the foundation of a coronary care unit (CCU). Although Paul created an acute care floor at BIH, the very first CCU in the US, in Bethany, Kansas, was equipped with machines created by Paul Zoll and Alan Belgard.

Some say Paul developed the first totally implantable pacemaker but that isn’t true. He and Alan Belgard were among the leaders in a race to develop and implant the first self-contained, long-term pacemaker in man, but in 1960 they were bested by another doctor-engineer team from Buffalo, NY.

Later that year, Paul and Howard Frank, a Beth Israel heart surgeon with whom he collaborated closely, became the second team to implant their version of a self-contained, long-term pacemaker in an adult patient. Shortly afterward, they became the first-in-the-world to implant one in a child.

In my mind, the most lasting of Paul’s accomplishments is the transthoracic defibrillator and his devotion to preventing and treating sudden death, to resuscitating and reanimating the victims. He put our hospital on the international map as a place where life-threatening arrhythmias could be prevented and treated.

What was Dr. Zoll like as a person?

Dr. Cohen: He was an extremely private man. He never promoted his accomplishments. He had one mission and that was to help people, and he didn’t care if he was liked or not. His energies were with his patients, his family and a select group of friends. He had a pool and tennis court behind his house, and he enjoyed taking his boat to Lake Cochituate for water skiing with his family. He worked on his medical manuscripts in the kitchen at night and even when relaxing at poolside, he stayed in touch with his medical practice by a telephone on a long cord that stretched from the house to the pool.

 

Paul was modest, shy and reclusive, with a slight build, short stature and ears that resembled jug handles. He was more comfortable in his research laboratory in the Kirstein basement at Beth Israel than at social gatherings, where he often sat in a corner.

He spent his entire professional life within a few blocks. He was born in Roxbury, went to Boston Latin School, Harvard College and Harvard Medical School, practiced and did his research at Beth Israel Hospital and lived with his wife and two children in Newton. Yet, by the time he died at age 87 in 1999, he had saved countless lives and the descendants of the medical devices he developed continue to save innumerable lives today.

When he had failures, he kept at it. His first attempt to get funding from the U.S. government was denied. He finally received a small grant from the Mass chapter of the American Heart Association (AHA). Paul also received a Paul Dudley White Award (from the AHA). He got the Lasker Award, which is America’s equivalent to the Nobel Prize. Some think he should have gotten a Nobel, but he wouldn’t promote himself.

How was Dr. Zoll controversial?

Dr. Cohen: His work was beyond the edges of convention and he was criticized. When he began his work on electrocardiac therapy, a vocal minority believed that reviving the dead was against the will of God.

Dr. Claude Beck of Western Reserve University School of Medicine was the high priest of opening the chest and pacing. Zoll once commented that at a national scientific meeting, the competitive Beck “wiped up the floor with me.” Paul was the only one thinking about pacing from the surface of the heart. Whenever you have somebody who’s responsible for a paradigm shift, it’s controversial.

When Paul developed external closed-chest pacing, he requested data, including information about the design of an electrical circuit from a stimulator that a Canadian team that had developed. The Canadian doctors claimed that they graciously responded. Hard feelings and controversy followed when Paul’s scientific articles didn’t credit that contribution. He argued that he had credited them for other suggestions, but that he and Alan Belgard had not seen or used the same circuit design.

That controversy continued for many years, even after his death. His success at reviving the dead made him notorious. His response was to avoid the limelight and intensify his efforts to prevent sudden death.

Would Dr. Zoll have been able to achieve his breakthroughs if he were operating in the realm of biomedical research today?

Dr. Cohen: There wasn’t any oversight back then, although I’ve been told they did have a committee and patients were asked to give their consent.

A band of five people like Paul’s team couldn’t do it today. They wouldn’t have the resources. Today it’s done by industry or industry and investigators. It’s multi-institutional and multinational, with thousands of patients enrolled in studies. There will never be another Paul Zoll who could accomplish what he did with so few resources.

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

October 2014

– See more at: http://www.bidmc.org/Centers-and-Departments/Departments/Cardiovascular-Institute/CVI-Newsletter/StaffordCohen.aspx#sthash.lAe3b9Kk.dpuf