Huang J, Ruse RB, Walcott GP, Litovsky S, Bohanan SJ, Gong DW, Kroll MW. Ascending Defibrillation Waveform Significantly Reduces Myocardial Morphological Damage and Injury Current.
JACC Clin Electrophysiol 2019;
5:854-862. [PMID:
31320015 DOI:
10.1016/j.jacep.2019.04.006]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/19/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES
This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model.
BACKGROUND
Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival.
METHODS
An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock.
CONCLUSIONS
Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.
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