Key result
Double sequential external shocks terminate refractory VF, resuscitating ~100% of patients refractory to standard shocks.
Why the study?
Refractory ventricular fibrillation can occur in up to 0.1% of electrophysiologic studies, and animal studies had shown that rapid sequential shocks may reduce the ventricular fibrillation threshold.
Does double sequential external defibrillation terminate refractory ventricular fibrillation in patients undergoing electrophysiologic studies when standard single-defibrillator shocks fail?
Observational (n=5)
Does double sequential external defibrillation terminate refractory ventricular fibrillation in patients undergoing electrophysiologic studies when standard single-defibrillator shocks fail?
Double sequential external shocks delivered via two defibrillators successfully terminated refractory ventricular fibrillation in all five patients when standard single-defibrillator shocks failed during electrophysiologic studies.
Hypothesis-generating for double sequential shocks in refractory VF; prospective trials needed before adoption.
Objectives A technique for terminating refractory ventricular fibrillation is described. Background Refractory ventricular fibrillation can occur in up to 0.1% of electrophysiologic studies. Animal studies have shown that rapid sequential shocks may reduce ventricular fibrillation threshold. Methods Five patients of 2,990 consecutive patients in a 3-year period experienced refractory ventricular fibrillation during 5,450 routine electrophysiologic studies. Multiple shocks were delivered by means of a single defibrillator. Double sequential shocks were delivered externally 0.5 to 4.5 s apart by means of two defibrillators with separate pairs of electrodes. Results In all patients, standard defibrillation was unsuccessful, but all were successfully resuscitated using the double sequential shocks. Conclusions This report stresses the importance of an additional defibrillator being readily available during electrophysiologic testing. This technique of rapid, double sequential external shocks may have general applicability, providing a simple and potentially lifesaving approach to refractory ventricular fibrillation.
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Hoch et al. (1994) conducted an observational in Refractory ventricular fibrillation during electrophysiologic studies (n=5). Double sequential external shocks vs. Standard defibrillation (multiple shocks via a single defibrillator) was evaluated on Successful resuscitation / termination of refractory ventricular fibrillation. Double sequential external shocks successfully resuscitated 100% (5/5) of patients with refractory ventricular fibrillation after standard single-defibrillator shocks failed (0%).
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