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PubMed1988

Internal cardiac defibrillation: single and sequential pulses and a variety of lead orientations.

A sequential pulse system for internal cardiac defibrillation incorporating catheter and patch electrodes with two current pathways has been shown to reduce defibrillation threshold in comparison to the single pulse technique. The relative advantage of the sequential pulse over the single pulse technique with other lead systems is not known. We compared defibrillation thresholds using sequential and single pulses delivered to a variety of lead orientations with the same electrode surface areas, when possible. Defibrillation threshold totals determined in halothane-anesthetized open-chest pigs averaged: For the single pulse shock passed between (1) superior vena cava (SVC) and left ventricular apical patch (LVA), 27.2 +/- 9.1 joules (J) and (2) LV epicardial patch (LVE) to right ventricular epicardial (RVE) patch leads, 16.5 +/- 2.1 J; and for the sequential pulse shock with two pulses passed between: (1) the SVC to RV intracavitary apex (RVA) and a quadripolar catheter in the coronary sinus to the RVA, 11.6 +/- 1.0 J; (2) the SVC to LVA and the LVE to RVE, 9.6 +/- 1.3 J and (3) the SVC to RVA and the LVE to RVA, 8.9 +/- 0.4 J. Defibrillation thresholds for sequential pulse shocks were all significantly lower than either of the defibrillation thresholds for single pulse shocks (p less than 0.001). We conclude that the sequential pulse system provides a substantial reduction in defibrillation threshold over the single pulse regardless of the lead system when the surface area and pulse characteristics are controlled. Sequential pulse technique may be valuable in the design of an implantable automatic defibrillator.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

A model to evaluate alternative methods of defibrillation threshold determination.

The voltage (or, equivalently, energy) at which defibrillation occurs for a specific episode of fibrillation can be represented by specifying or estimating the probability of successful defibrillation for each voltage or energy. This relation of voltage to probability is the probability function. For a series of attempts, the probability function predicts the frequency with which defibrillation will occur at a given voltage. By defining the defibrillation threshold (DFT) as the voltage at which the probability function takes on a specific value, say 50%, a method of defibrillation threshold determination can be evaluated by how accurately and precisely it estimates the "true" defibrillation threshold. By utilizing estimated probability functions from animals and humans, the relative performance of different methods of defibrillation threshold determination can be evaluated. Three methods were evaluated using published animal data and human clinical data: (1) stepping down to the first voltage that fails; (2) stepping up to the first voltage that succeeds; and (3) doing both 1 and 2 and averaging. In all cases, Method 3 has lower total error. Definitions of defibrillation threshold other than the 50% level can also be evaluated in this fashion.

Animals↗
PubMed1989

The effect of chronic oral and acute intravenous amiodarone administration on ventricular defibrillation threshold using implanted electrodes in dogs.

The effect of acute intravenous administration and chronic oral loading of amiodarone on defibrillation threshold was evaluated in normal anesthetized dogs using implanted superior vena caval spring and left ventricular patch electrodes. The effect of oral loading with amiodarone was evaluated by comparing three groups of six dogs each that received either no drug, 200 mg/day for 9 days, or 400 mg/day for 9 days. Defibrillation threshold was evaluated by administering a fixed sequence of shocks with increasing energies until defibrillation was successful. Defibrillation was determined 13 times in each animal. The mean defibrillation threshold (plus or minus standard error of the mean) was 7.5 +/- 0.3 J in the control group, 15.4 +/- 0.6 J in the group receiving amiodarone 200 mg/day, and 17.9 +/- 0.8 J for the group receiving 400 mg/day. These values are significantly different using analysis of variance and Tukey's test. The acute effect of intravenous amiodarone, 5 mg/Kg was evaluated in five dogs using each dog as its own control. The mean defibrillation threshold during control period was 10.8 +/- 0.4 J, and during the first two hours after amiodarone administration was 10.8 +/- 0.4 J. There was no significant difference. Thus, in this study oral administration of a loading dose of amiodarone comparable to that used in patients produced a dose dependent increase in defibrillation threshold, whereas no change in defibrillation threshold was observed acutely after intravenous administration.

Administration, Oral↗
PubMed1993

Influence of external defibrillator electrode polarity on cardiac resuscitation.

Eight hundred forty-seven consecutive patients discovered in cardiac arrest by first responding firefighters received initial defibrillation attempts using automatic external defibrillators. The effect of electrode polarity on defibrillation and resuscitation was determined in the subset of 289 (34%) with ventricular fibrillation in a prospective, randomized trial. The ECG was recorded in 205 consecutive patients whose initial rhythm was ventricular fibrillation. Eighty-seven of 114 patients (76%) in whom the apex chest electrode was positive were defibrillated with the first 200-joule shock, compared to 70 of 91 patients (77%) in whom the apex electrode was negative. There was no difference in the type of rhythm established, e.g., organized versus brady-asystole following defibrillation with either electrode polarity. Resuscitation was possible in 56% of patients in whom the apex electrode was positive and 60% of those in whom the apex electrode was of negative polarity. Hospital survival rates (26% vs 27%) were also similar for both treatment groups. Unlike results during experimental external defibrillation of animals or those obtained using implantable defibrillators, this randomized trial of external defibrillation conducted during attempted out-of-hospital resuscitation showed no difference in outcomes related to electrode polarity.

Aged↗
PubMed2003

The strength-duration relationship of monophasic waveforms with varying capacitance sizes in external defibrillation.

The shape of the shock waveform influences defibrillation efficacy. However, the optimal combination between capacitance size and truncation/tilt which can determine monophasic waveform's shape, has not been determined for external defibrillation. The purpose of this study was to assess the effects of varying capacitance and tilt on external defibrillation using exponential monophasic waveforms. In a pig model of external defibrillation (n = 10, 30 +/- 6 kg), nine exponential monophasic waveforms combining three capacitance values (30 microF, 60 microF, and 120 microF) and three tilt values (55%, 75%, and 95%) were tested randomly. The energy and leading edge voltage at 50% defibrillation success (E50 and V50) were used to evaluate defibrillation efficacy. E50 and V50 were determined by the Bayesian technique. The lowest stored E50 for the 30microF, 60 microF, and 120 microF waveforms were 90 +/- 12 J (95% tilt), 106 +/- 45 J (55% tilt), and 107 +/- 52 J (75% tilt), respectively. The lowest V50 for the 30 microF, 60 microF, and 120 microF waveforms were 2,439 +/- 166 V (95% tilt), 1,849 +/- 375 V (55% tilt), and 1,301 +/- 322 V (75% tilt), respectively. The average current at external defibrillation threshold demonstrated a strength versus pulse duration relationship similar to that seen with pacing. Reducing capacitance has the same effect as truncating the waveform. The E50 is more sensitive to tilt values changes in larger capacitance waveforms. This study suggests that the optimal combination between capacitance and tilt may be 120 microF and 55%-75% for external defibrillation.

Animals↗
PubMed1995

Characteristics of multiple-shock defibrillation.

INTRODUCTION: A new method for defibrillation allows two shocks to be combined to defibrillate with reduced current by adjusting their separation according to the cycle length of the fibrillation event. We investigated various aspects of this new method to better understand its characteristics and applicability to defibrillation. METHODS AND RESULTS: In 48 pentobarbital-anesthetized dogs, we measured the current for 50% defibrillation success using the new method with sequences of rectangular shocks. Group 1 studied the role of shock total duration and found that two-shock sequences followed a strength-duration curve similar to, but below, that for single shocks. Group 2 studied the role of amplitude and duration balance between shocks and found that two-shock sequences with equal shocks performed best. Group 3 studied whether the new method could be used with either biphasic waveforms or sequential shock pathways. Current reduction for the combined methods equaled the product of current reduction by each method, demonstrating that these methods can be effectively combined. Group 4 extended the method to include three-shock and four-shock sequences and found that a fourth shock did not further improve defibrillation. The optimum three-shock sequence required 33% lower current (P < 0.002) and 34% greater energy (P < 0.095 = NS) than a single shock. CONCLUSIONS: The new method allows defibrillation to be distributed over several fibrillatory cycles and has an improved strength-duration relationship. Two- or three-shock sequences using equal shocks permit a substantial reduction of defibrillation current that can be combined with the reduction for biphasic and sequential methods. Thus, the method may have application in low-current defibrillation devices.

Animals↗
PubMed1997

Chemical cardiac sympathetic denervation hampers defibrillation in the dog.

INTRODUCTION: Cardiac defibrillation is influenced by several physical and nonphysical factors. Previous animal studies have shown that beta-adrenergic stimulation facilitates the process of defibrillation. The purpose of this study was to examine the effects of chemical sympathetic denervation on the ability to defibrillate the canine heart. METHODS AND RESULTS: Twelve chronically instrumented dogs underwent serial measurements of the energy required to defibrillate the heart, ten before and after treatment with 50 mg/kg 6-hydroxydopamine (6-OHDA). Two of the animals received 1% ascorbic acid in 0.9% saline solution (the vehicle) only, and three dogs received the vehicle followed several weeks later by 6-OHDA. Following treatment with 6-OHDA, the energy to defibrillate the heart rose from 11.9 +/- 7.4 J (baseline 1) and 14.3 +/- 8.7 J (baseline 2) to 23.3 +/- 10.8 J (P < 0.01 and < 0.05, respectively). In contrast, following saline administration, no significant change was measured in the energy required to defibrillate the heart. After 6-OHDA, 5 of the 10 animals could not be defibrillated versus none of 5 after saline treatment (Chi square 3.750, P = 0.053). In surviving animals, a return of measurements to, or toward, baseline was measured after active treatment. CONCLUSIONS: In this chronically instrumented, closed chest animal model, chemical sympathetic denervation with 6-OHDA hampered the process of cardiac defibrillation. These results support previous observations of a modulating effect of this process by adrenergic activity.

Animals↗
PubMed1997

Effect of waveform tilt on defibrillation thresholds in humans.

INTRODUCTION: Despite the common use of the implantable cardioverter defibrillator to treat patients with life-threatening ventricular arrhythmias, the mechanism of defibrillation and the optimal waveform for implanted devices are poorly understood. All of the currently available pulse generators deliver exponentially declining pulses that are either automatically or manually truncated to achieve tilts of about 50% to 65%. Although this value was chosen based on experimental animal data, several theoretical models have been developed to describe defibrillation, which raise into question this choice of waveform shape. Accordingly, the present study was designed to test the effect of waveform tilt on defibrillation efficacy in humans. METHODS AND RESULTS: Twenty-three patients undergoing cardioverter defibrillator implantation were studied. Monophasic defibrillation thresholds (DFTs) were measured using a single reversal protocol at 35%, 50%, 65%, and 80% tilts by altering the pulse width of the shock. Mean defibrillation impedance was 41 +/- 6 omega. The DFT, measured by either leading-edge voltage or stored energy, was insensitive to altering the waveform tilt from 50% to 80%, only increasing when the tilt was reduced to 35%. A tilt of 65% yielded the lowest DFT voltage in only 8 of 23 patients. Significantly lower DFTs (> or = 40 V) were obtained using other tilts in seven patients. When the relationship between average current and pulse width was fit with a Weiss-Lapicque model, the data yielded a mean chronaxie of 4.6 +/- 3.0 msec and a rheobase of 4.2 +/- 1.7 A, but considerable patient variability was observed. CONCLUSION: On average, DFTs in humans are insensitive to altering monophasic waveform tilts between 50% and 80%. There is, however, considerable patient variability, raising into question the premise that a single defibrillator waveform tilt is best for all patients.

Aged↗
PubMed1999

Biventricular shocking leads improve defibrillation efficacy.

INTRODUCTION: A single lead active can configuration has been widely used in patients with life-threatening ventricular arrhythmias. Occasionally, however, such a defibrillation lead configuration may not achieve adequate defibrillation threshold (DFT). The purpose of this study was to determine whether addition of a left ventricular (LV) lead can improve defibrillation efficacy. METHODS AND RESULTS: Three transvenous defibrillation leads (8.3-French with a 5-cm long unipolar coil) were placed in the right ventricle (RV), LV, and superior vena cava (SVC), along with an active can (92 cm2) in the left subpectoral area. The DFT stored energy of seven combinations of these defibrillation leads were compared in a pig ventricular fibrillation model using a biphasic defibrillation waveform (125 microF, 6.5/3.5 msec). A biventricular leads active can configuration in which the RV and LV leads were of the same polarity reduced the DFT stored energy by approximately 35% when compared to a single RV lead active can configuration (9.6 +/- 3.0 J vs 15.0 +/- 7.2 J, respectively, P = 0.02). Moreover, adding a SVC lead further reduced the DFT energy (8.4 +/- 3.3 J). CONCLUSION: A biventricular leads active can configuration can significantly improve defibrillation efficacy as compared to a single lead active can configuration. In such a defibrillation lead configuration, the polarity of RV and LV leads should be the same.

Animals↗
PubMed1987

Adrenergic effects on internal cardiac defibrillation threshold.

Autonomic neural tone modulates arrhythmias and could affect the efficacy of an implantable defibrillator if defibrillation threshold is also altered by changes in neural activity. We determined the effects of alpha- and beta-adrenoceptor agonists and antagonists on the energy requirement for defibrillation using a sequential-pulse technique in anesthetized pigs. The doses for each drug were selected based on the results of dose-response curves. The mean defibrillation threshold was 10.2 +/- 0.65 J (mean +/- SE) in control and 10.0 +/- 0.84, 9.4 +/- 0.87 and 8.9 +/- 0.89 J during phenylephrine infusions of 0.7, 1.35, and 2.0-4.0 micrograms X kg-1 X min-1 [n = 8, P = not significant (NS)]. Phenylephrine at all infusion rates increased the ventricular fibrillation threshold, indicating that effects on the ventricular fibrillation threshold may occur independent of changes in defibrillation threshold. No significant change was observed in the defibrillation threshold before and after administration of isoproterenol (6.5 +/- 0.72 and 6.7 +/- 0.93 J, n = 8, P = NS). Similarly, no change in defibrillation thresholds was observed after 1.5-2.0 mg/kg phentolamine (8.5 +/- 0.85 and 7.9 +/- 0.93 J, n = 8, P = NS) or 3.0-6.0 mg/kg atenolol (10.0 +/- 1.7 and 10.3 +/- 2.6 J, n = 8, P = NS). However, when defibrillation threshold was determined using a single-pulse method, isoproterenol infusion produced a significant decrease (17.3 +/- 1.5 vs. 14.6 +/- 1.9 J, n = 7, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Recurrent appearance of protective zones after an unsuccessful defibrillation shock.

This study was designed to test the hypothesis that protective zones appear recurrently at the initiation of ventricular fibrillation (VF) and that when shocks are delivered during protective zones, there can be a decrease in the defibrillation energy requirement. A total of 12 open-chest dogs were studied. Six dogs were included in protocol 1. After eight baseline pacing stimuli (S1) with cycle lengths of 300 ms, a strong premature stimulus (S2) (73 +/- 10 mA) was given to induce VF. In subsequent episodes, a second strong premature stimulus (S3) was given at progressively longer S2-S3 intervals in 20-ms increments. In protocol 2, we delivered unsuccessful defibrillation shocks via a transvenous defibrillation electrode placed in the right ventricular apex of six dogs. A second shock was then delivered to patch electrodes on the right ventricular outflow tract and the posterior wall of the left ventricle. The results of protocol 1 showed that the S3 terminated reentry and prevented VF only when it occurred at specific time intervals after the S2 (the protective zones). These protective zones appear recurrently up to 375 ms after the onset of VF. The results of protocol 2 showed that the total energy required for successful defibrillation was dependent on the interval between the first and second shocks. Intervals favoring effective defibrillation (protective zones) appeared recurrently for up to 280 ms after the first shock. When the second shock was delivered during a protective zone, the defibrillation energy requirement was decreased by up to 23% (from 13.1 +/- 2.0 to 10.1 +/- 1.8 J, P < 0.003). However, when the shock was delivered outside the protective zone, a significant increase in the defibrillation energy requirement was observed. We conclude that protective zones appear recurrently at the onset of VF and after unsuccessful defibrillation shocks.

Animals↗
PubMed1997

Relationship between "extension of refractoriness" and probability of successful defibrillation.

The "extension of refractoriness" hypothesis, which suggests that the shock halts fibrillation by extending the refractory period, has not been directly tested. Defibrillation (5 isolated rabbit hearts; 111 episodes) was attempted by 8-ms pulses (65% tilt) delivered through epicardial patches. Monophasic action potentials were recorded in a low current density region (6.3 V/cm at 90% success). Fifty shocks failed to convert; 61 shocks successfully defibrillated. Postshock response duration (from shock to repolarization) was significantly longer for successful type A (with no postshock activations) defibrillation (102.3 +/- 7.5 ms) than for unsuccessful defibrillation (47.6 +/- 4.3 ms; P < 0.0001) for shocks occurring during the last 40% of the fibrillation action potential. Probability of success and postshock response duration both increased with current intensity. However, at each intensity, response durations for successful defibrillation were significantly longer than those for unsuccessful defibrillation. A minimum prolongation of 75 ms was associated with type A defibrillation. These results suggest that shock-induced response duration correlates with successful defibrillation and that a response of 75 ms is required to completely block fibrillation wavefronts.

Action Potentials↗
PubMed1986

Internal cardiac defibrillation in man: pronounced improvement with sequential pulse delivery to two different lead orientations.

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)

Adult↗
PubMed1988

Energy, current, and success in defibrillation and cardioversion: clinical studies using an automated impedance-based method of energy adjustment.

The purposes of this study were two. First, we wanted to evaluate in patients a technique for automated adjustment of selected energy for defibrillation or cardioversion based on transthoracic impedance. Second, we wanted to define the relationship of peak current and shock success in various arrhythmias. Applying a previously validated method of predicting transthoracic impedance in advance of any shock, we modified defibrillators to automatically double the operator-selected energy if the predicted impedance exceeded 70 omega. Success rates of shocks given for ventricular and atrial arrhythmias from these modified energy-adjusting defibrillators were compared with success rates for shocks given from standard defibrillators. We prospectively collected data on 347 patients who received a total of 1009 shocks. Low-energy (100 J) shocks given to high-impedance (greater than or equal to 70 omega) patients had a poor success rate; in such high-impedance patients significant improvement in shock success rate was achieved by the energy-adjusting defibrillators. For example, when 100 J shocks were selected for high-impedance patients in ventricular fibrillation the energy-adjusting defibrillators achieved a shock success rate of 75%, whereas standard defibrillators achieved a shock success rate of only 36% (p less than .01). Similar improvements were seen for ventricular tachycardia and atrial fibrillation. Thus, automated energy adjustment based on transthoracic impedance is a beneficial approach to defibrillation and cardioversion. For ventricular fibrillation, atrial fibrillation, and atrial flutter there was a clear relationship between peak current and shock success.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1992

A permanent transvenous lead system for an implantable pacemaker cardioverter-defibrillator. Nonthoracotomy approach to implantation.

A transvenous lead system for implantable defibrillators would obviate a surgical thoracotomy and reduce the morbidity and mortality associated with implantation. We evaluated the clinical performance of a new nonthoracotomy lead system that included a defibrillation lead in the coronary sinus. At the time of defibrillator implantation, transvenous defibrillation leads were inserted percutaneously through the left subclavian vein into the right ventricular apex (RVA), superior vena cava (SVC), and distal coronary sinus (CS) under fluoroscopic guidance. A subcutaneous patch electrode (SQ) was also available if required. The first single- or dual-pathway electrode configuration that successfully terminated three of four ventricular fibrillation episodes using 18 J or less was implanted. Eleven men and three women aged 39-77 years (60.0 +/- 10.1 years) with left ventricular ejection fraction ranging from 16% to 63% (33.4 +/- 13.1%) were evaluated. Nine presented with ventricular tachycardia, three had ventricular fibrillation, and two had both. A totally transvenous lead system (RVA/CS/SVC) was implanted in seven patients (50%) with a mean defibrillation threshold of 15.6 +/- 2.9 J (10-18 J). Four patients received a partial transvenous lead system (RVA/CS/SQ). An effective nonthoracotomy lead system was not found in three patients; they received epicardial electrodes. After cumulative follow-up of 73 patient-months, nine patients remain alive and free of problems related to the implanted nonthoracotomy leads. One patient died of respiratory failure 3 months after defibrillator implant, and the leads from another patient were removed at 9 months because of bacterial infection. A transvenous lead system that includes a defibrillation lead in the coronary sinus is a safe, reliable, and, at least in the short term, effective nonthoracotomy approach for automatic defibrillator implantation.

Adult↗
PubMedDate not supplied

Automated external defibrillators in National Collegiate Athletic Association Division I Athletics.

BACKGROUND: Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. METHODS: Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. RESULTS: Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. CONCLUSIONS: Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.

Chi-Square Distribution↗
PubMed2004

External cardiac defibrillation does not cause acute histopathological changes typical of thermal injuries in pigs with in situ cerebral stimulation electrodes.

UNLABELLED: Parkinson's disease patients with long-term L-dopa syndrome may benefit from an implanted cerebral stimulation device. When advanced life support demands cardioversion or defibrillation in these patients, undesired effects of monophasic electroshocks might occur in brain tissue adjacent to the stimulation electrodes (e.g., thermal injury), but also in the stimulation device itself. Thus, in this animal study (n = 6 pigs), we investigated the effects of repeated defibrillation (2 x 200 J [n = 1] and 2 x 360 J [n = 5]) at the implantation site of cerebral stimulation electrodes and on stimulation device function. Repeated external cardiac defibrillation did not cause acute histopathologic changes typical of thermal injury to brain tissue adjacent to the cerebral stimulation electrodes. Functionality of the stimulator device after defibrillation, however, ranged from normal to total loss of function. Therefore, when defibrillation is performed, the greatest possible distance between the defibrillation site and the stimulator device implantation site should be considered. Subsequent testing of the stimulator device's function is mandatory. IMPLICATIONS: Repeated cardiac defibrillation did not cause histopathologic changes typical of thermal injury at the implantation site of cerebral stimulation electrodes. The function of the stimulator device after defibrillation, however, ranged from normal to total loss of function.

Adenosine↗
PubMed1999

Defibrillator analyzers.

Defibrillator analyzers automate the inspection and preventive maintenance (IPM) testing of defibrillators. They need to be able to test at least four basic defibrillator performance characteristics: discharge energy, synchronized-mode operation, automated external defibrillation, and ECG monitoring. We prefer that they also be able to test a defibrillator's external noninvasive pacing function--but this is not essential if a facility already has a pacemaker analyzer that can perform this testing. In this Evaluation, we tested seven defibrillator analyzers from six suppliers. All seven units accurately measure the energies of a variety of discharge wave-forms over a wide range of energy levels--from 1 J for use in a neonatal intensive care unit to 360 J for use on adult patients requiring maximum discharge energy. Most of the analyzers are easy to use. However, only three of the evaluated units could perform the full range of defibrillator tests that we prefer. We rated these units Acceptable--Preferred. Three more units could perform four of the five tests, they could not test the pacing feature of a defibrillator. These units were rated Acceptable. The seventh unit could perform only discharge energy testing and synchronized-mode testing and was difficult to use. We rate that unit Acceptable--Not Recommended.

Electric Countershock↗