TY - JOUR
T1 - Reduced motion external defibrillation
T2 - Reduced subject motion with equivalent defibrillation efficiency validated in swine
AU - Schmidt, Ehud J.
AU - Elahi, Hassan
AU - Meyer, Eric S.
AU - Baumgaertner, Ryan
AU - Neri, Luca
AU - Berger, Ronald D.
AU - Tandri, Harikrishna
AU - Hunter, David W.
AU - Cohen, Steven P.
AU - Oberdier, Matt T.
AU - Halperin, Henry R.
N1 - Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2022/7
Y1 - 2022/7
N2 - Background: External defibrillators are used for arrhythmia cardioversion and for defibrillating during cardiac arrest. During defibrillation, short-duration biphasic pulses cause intense motion due to rapid chest-wall muscle contraction. A reduced motion external defibrillator (RMD) was constructed by integrating a commercial defibrillator with a Tetanizing-waveform generator. A long-duration, low-amplitude, tetanizing waveform slowly stimulated the chest musculature before the biphasic pulse, reducing muscle contraction during the shock. Objective: The purpose of this study was to evaluate RMD defibrillation in swine for subject motion during defibrillation pulses and for defibrillation effectiveness. RMD defibrillation can reduce the duration of arrhythmia ablation therapy or simplify cardioversion procedures. Methods: The tetanizing unit delivered a triangular 1-kHz pulse of 0.25- to 2.0-second duration and 10- to 100-V peak amplitude, subsequently triggering the conventional defibrillator to output standard 1- to 200-J energy biphasic pulses at the next R wave. Forward limb motion was evaluated by measuring peak acceleration and limb work during RMD (tetanizing + biphasic) or biphasic pulse–only waveforms at 10–3-second sampling rate. Seven swine were arrested electrically and subsequently defibrillated. Biphasic pulse–only and RMD defibrillations were repeated 25–35 times per swine, varying tetanizing parameters and biphasic pulse energy. Defibrillation thresholds (DFTs) were established by measuring the minimum energy required to restore sinus rhythm with biphasic pulse–only or RMD defibrillations. Results: Two forward-limb acceleration peaks occurred during both the tetanizing waveform and biphasic pulse, indicating rapid and slower nociceptic (pain sensation) nerve fiber activation. Optimal RMD tetanizing parameters (25–35 V, 0.25- to 0.75-second duration), relative to biphasic pulse–only defibrillations, resulted in 74% ± 10% smaller peak accelerations and 85% ± 10% reduced limb work. DFT energies were identical when comparing RMD to biphasic pulse–only defibrillations. Conclusion: Relative to conventional defibrillations, RMD defibrillations maintain rhythm restoration efficiency with drastically reduced subject motion.
AB - Background: External defibrillators are used for arrhythmia cardioversion and for defibrillating during cardiac arrest. During defibrillation, short-duration biphasic pulses cause intense motion due to rapid chest-wall muscle contraction. A reduced motion external defibrillator (RMD) was constructed by integrating a commercial defibrillator with a Tetanizing-waveform generator. A long-duration, low-amplitude, tetanizing waveform slowly stimulated the chest musculature before the biphasic pulse, reducing muscle contraction during the shock. Objective: The purpose of this study was to evaluate RMD defibrillation in swine for subject motion during defibrillation pulses and for defibrillation effectiveness. RMD defibrillation can reduce the duration of arrhythmia ablation therapy or simplify cardioversion procedures. Methods: The tetanizing unit delivered a triangular 1-kHz pulse of 0.25- to 2.0-second duration and 10- to 100-V peak amplitude, subsequently triggering the conventional defibrillator to output standard 1- to 200-J energy biphasic pulses at the next R wave. Forward limb motion was evaluated by measuring peak acceleration and limb work during RMD (tetanizing + biphasic) or biphasic pulse–only waveforms at 10–3-second sampling rate. Seven swine were arrested electrically and subsequently defibrillated. Biphasic pulse–only and RMD defibrillations were repeated 25–35 times per swine, varying tetanizing parameters and biphasic pulse energy. Defibrillation thresholds (DFTs) were established by measuring the minimum energy required to restore sinus rhythm with biphasic pulse–only or RMD defibrillations. Results: Two forward-limb acceleration peaks occurred during both the tetanizing waveform and biphasic pulse, indicating rapid and slower nociceptic (pain sensation) nerve fiber activation. Optimal RMD tetanizing parameters (25–35 V, 0.25- to 0.75-second duration), relative to biphasic pulse–only defibrillations, resulted in 74% ± 10% smaller peak accelerations and 85% ± 10% reduced limb work. DFT energies were identical when comparing RMD to biphasic pulse–only defibrillations. Conclusion: Relative to conventional defibrillations, RMD defibrillations maintain rhythm restoration efficiency with drastically reduced subject motion.
KW - Cardioversion
KW - Defibrillation effectiveness
KW - Defibrillation motion
KW - Sudden cardiac arrest
KW - Ventricular tachycardia
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U2 - 10.1016/j.hrthm.2022.02.021
DO - 10.1016/j.hrthm.2022.02.021
M3 - Article
C2 - 35240311
AN - SCOPUS:85127336127
SN - 1547-5271
VL - 19
SP - 1165
EP - 1173
JO - Heart Rhythm
JF - Heart Rhythm
IS - 7
ER -