title: Bidirectional transvenous/subcutaneous defibrillation of ventricular fibrillation in dogs: success rates, energy requirements, currents, voltages and impedance.
abstract: Four hundred and thirteen defibrillations of alternating current-induced ventricular fibrillation were performed in 10 halothane-anaesthetized dogs (body weight: 24.5-30.5 kg). Success rates, energy demands, currents, peak voltages and impedance were determined. A transvenous catheter electrode system (Medtronic 6880, right ventricular apex and superior vena cava, distance 100 or 150 mm) and subcutaneous patch electrodes (Intec 67 L, 2nd/3rd and/or 3rd/4th left intercostal space) were used for bidirectional defibrillation. Loading voltages ranged from 600 to 850 V. With an electrode distance of 100 mm and a pulse duration of 2 ms separated by 1 ms, success rates were 100%, 40% and 0% for 850.650 and 600 V, respectively. With a 3-ms pulse duration, the corresponding rates were 100%, 60% and 50%. With a 2-ms pulse duration, successful defibrillation was achieved with energies lower than 15 J in 27%, with energies between 15 and 20 J in 77%, and 100% with energies higher than 20 J. Defibrillation currents were 4.4-9.3 A for pulse 1 (superior vena cava/ventricular apex) and 6.3-13.4 A for pulse 2 (patch/ventricular apex), respectively. Effective peak voltages ranged from 510 to 787 V and from 514 to 777V and averaged 89.6% of the loading voltages. Impedance values (peak voltage/current) were 75.5-117.7 (pulse 1) and 51.7-94.9 Ohms (pulse 2). Fifty consecutive defibrillations in one animal resulted in a decrease of impedance (114.6 to 84.9 Ohms, pulse 1:75.4 to 53.0 Ohms, pulse 2). Defibrillation of ventricular fibrillation can be achieved with acceptably low energies using a bidirectional transvenous/subcutaneous system, avoiding thoracotomy and general anaesthesia for implantation of the defibrillation system.
authors.affiliation: Medical Hospital, Düsseldorf, Department of Cardiology, Pneumology and Angiology, F.R.G.
authors.forename: T
authors.initials: T
authors.lastname: Budde
authors.forename: N B
authors.initials: NB
authors.lastname: Vukmirovic
authors.forename: J M
authors.initials: JM
authors.lastname: Soriano-Romero
authors.forename: S
authors.initials: S
authors.lastname: Abu-Ghazaleh
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: F K
authors.initials: FK
authors.lastname: Schmiel
authors.forename: B
authors.initials: B
authors.lastname: Pölitz
authors.forename: G
authors.initials: G
authors.lastname: Arnold
authors.forename: G
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial; D004285:Dogs; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D014693:Ventricular Fibrillation / Q000628:therapy*