Author + information
- Received October 5, 1988
- Revision received December 6, 1988
- Accepted December 11, 1988
- Published online July 1, 1989.
- Gust H. Bardy, MD FACC∗,
- Tom D. Ivey, MD,
- Margaret D. Allen, MD,
- George Johnson, BSEE and
- H.Leon Greene, MD FACC
- ↵∗Address for reprints: Gust H. Bardy. MD. Harborview Medical Center, 325 Ninth Avenue, Seattle. Washington 98104
Sixteen out-of-hospital survivors of ventricular fibrillation underwent a prospective, randomized, intraoperative comparison of sequential pulse and single pulse defibrillation with use of two distinct electrode systems and waveform shapes currently available for clinical use. Defibrillation was tested alternately with either the single pulse or the sequential pulse system 10 s into an episode of ventricular fibrillation. Sequential pulse defibrillation was performed with two 4 ms truncated exponential pulses of constant duration delivered to three equally spaced oval epicardial patch electrodes composed of concentric coils. The posterior left ventricular electrode served as the common cathode. The first anode was over the anterior right ventricle and the second anode was over the anterior left ventricle. Single pulse defibrillation was performed with the standard intracardiac defibrillation system with use of a single truncated exponential pulse with a fixed 65% tilt delivered across two rectangular, wire mesh epicardial patch electrodes positioned over the anterior right ventricle and posterolateral left ventricle.
During defibrillation threshold determination, voltage and current waveforms were recorded and used to determine pulsing resistance and delivered and stored energy. Average defibrillation threshold leading edge voltage for the single pulse technique was 273 ± 101 V compared with 246 ± 67 V (11% less) for the sequential pulse technique (p = 0.136). Defibrillation threshold leading edge current for the single pulse technique was 6.7 ± 2.5 A compared with 5.2 ± 1.7 A (29% less) for the sequential pulse method (p = 0.005). The defibrillation threshold delivered energy was 5.6 ± 4.0 J for the single pulse technique and 3.5 ± 1.8 J (38% less) for the sequential pulse technique (p = 0.021). The defibrillation threshold stored energy for the single pulse technique was 6.3 ± 4.3 J compared with 4.0 ± 2.0 J (37% less) for the sequential pulse technique (p = 0.013).
In survivors of cardiac arrest, the clinically available sequential pulse three electrode defibrillation system is at least as viable as the standard single pulse two electrode system for defibrillation of the heart. In some individuals, the sequential pulse system utilizes substantially lower current and energy to defibrillate than does the single pulse system.
☆ This work was supported in part by Grants R23-HL36170-01 and R01 HL31472-01A3 from the National Institutes of Health, Bethesda, Maryland and by a grant from the American Heart Association, Washington Affiliate. Seattle. Dr. Bardy is a recipient of the National Institutes of Health Young Investigator Award
- Received October 5, 1988.
- Revision received December 6, 1988.
- Accepted December 11, 1988.