Circulation, Vol 73, 484-491, Copyright © 1986 by American Heart Association
DL Jones, GJ Klein, GM Guiraudon, AD Sharma, MJ Kallok, JD Bourland and WA Tacker
Wider applicability of an implantable automatic defibrillator depends on
achieving internal cardiac defibrillation consistently with the lowest
possible energy. In animal studies, we have found that the cardiac
defibrillation threshold could be reduced when sequential shocks separated
in time and spacially arranged were delivered to the heart. We compared
internal cardiac defibrillation using a single pulse shock delivered
through an intravascular catheter with this new method for internal cardiac
defibrillation in patients undergoing cardiac surgery for the correction of
arrhythmias. For the single pulse shock and the first pulse of the
sequential pulse shock, current was passed through an intravascular
catheter with the catheter cathode at the apex of the right ventricle and
the anode at the superior vena cava-atrial junction region. The second
pulse of the sequential pulse countershock was delivered between the
catheter cathode in the right ventricular apex and an oval plaque electrode
secured on the laterobasal left ventricular epicardium as anode. With the
single pulse alone for shock delivery, 12 patients could be defibrillated
with an average of 20.1 +/- 16.8 J, with a corresponding leading-edge peak
voltage and current of 836 +/- 319 V and 9.4 +/- 4.5 A, respectively.
However, two of the patients could not be defibrillated with energies below
50 J. With the sequential pulse shock delivery, a significant reduction in
all values were recorded. Mean total energy for defibrillation averaged 7.7
+/- 6.0 J. Leading-edge peak voltage and current from the catheter averaged
430 +/- 148 V and 5.0 +/- 2.8 A, respectively.(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Internal cardiac defibrillation in man: pronounced improvement with sequential pulse delivery to two different lead orientations
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