Key result
Double pulse defibrillation waveforms showed an adverse interaction when spacing was 60%-70% of fibrillation cycle length, but were as effective as a single pulse at 110%-130% spacing.
Why the study?
Does double pulse transthoracic defibrillation with spacing based on percent fibrillation cycle length improve defibrillation efficacy in a calf model?
Does double pulse transthoracic defibrillation with spacing based on percent fibrillation cycle length improve defibrillation efficacy in a calf model?
In a calf model, double pulse defibrillation efficacy depends on pulse spacing relative to fibrillation cycle length, with critical ranges causing refibrillation.
Avoid critical spacings in double-pulse defibrillation to limit refibrillation risk; leaves open optimal parameters for clinical translation.
Recent studies have found that when multiple pulses of energy are used for defibrillation with implantable electrodes, the spacing between these pulses is better determined as a percentage of the fibrillation cycle length (CL), rather than as a fixed function of time. Here, this concept is further tested in the transthoracic defibrillation of calves, which are approximately the size of heavy humans. Eleven 90-110 kg calves (101 +/- 6 kg) were used in evaluating the effectiveness in achieving transthoracic ventricular defibrillation of ten double pulse waveforms (two 50 A 4-ms rectangular monopulses) having leading edge-to-edge spacings of 4 ms (a 50 A 8-ms rectangular monopulse) and 50, 60, 70, 80, 90, 100, 110, 120, 130 percent fibrillation CL, respectively. In each of these waveforms, the total time when 50 A current was flowing (on time) was 8 ms. Our results show an unequivocal adverse interaction between the pulses, when the spacing is around 60%-70% fibrillation CL; but that the two pulses combined to defibrillate as effectively as a single 8-ms pulse when the spacing is around 110%-130% fibrillation CL. Electrocardiographic analysis suggests that the adverse interaction is due to a refibrillation phenomenon. This study confirms that double pulses can interact and have a negative effect on defibrillation efficacy. Our data suggests that the mechanism of this interaction involves the second pulse reinitiating fibrillation when the pulse separation is in a critical range of values. Our results are also compatible with the hypothesis that the spacing of multiple pulses is better determined as a percentage of the fibrillation CL than as absolute time, although more study is necessary to fully test this hypothesis.
No takes yet. Share an insight, caveat, or question.
McDaniel et al. (1999) studied Ventricular fibrillation (n=11). Double pulse waveforms with spacing determined as a percentage of fibrillation cycle length vs. Single 8-ms pulse (4 ms spacing leading edge-to-edge) was evaluated on Effectiveness in achieving transthoracic ventricular defibrillation. Double pulse defibrillation waveforms showed an adverse interaction when spacing was 60%-70% of fibrillation cycle length, but were as effective as a single pulse at 110%-130% spacing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: