Ineffectiveness of precordial thump for cardioversion of malignant ventricular tachyarrhythmias.
BACKGROUND
The Precordial Thump (PT) is commonly used for cardiopulmonary resuscitations both in and out of hospitals. However, the support for its efficiency relies mainly on sporadic cases. In this current prospective large study, we tested the effectiveness and safety of PT in a wide range of malignant ventricular tachyarrhythmias.


METHODS
The study included 80 patients who underwent electrophysiological study and/or implantation of a cardiodefibrillator device. During these procedures, once a malignant ventricular tachyarrhythmia was induced, PT was used as the first treatment option. If the PT failed, other means were used to discontinue the arrhythmia.


RESULTS
Polymorphic ventricular tachycardia occurred in 32 (40%) patients, ventricular fibrillation in 28 (35%) patients, and 20 (25%) patients had sustained monomorphic ventricular tachycardia. Except in one patient with monomorphic ventricular tachycardia, the PT was unsuccessful in terminating any of the other malignant tachyarrhythmias, and internal or external defibrillation was eventually required in all other 79 (99%) patients. The PT was not associated with any damage either to the sternal bone, ribs, or to the cardiodefibrillator device.


CONCLUSIONS
PT is not effective in terminating malignant ventricular tachyarrhythmia and should be reserved to a situation in which a defibrillator is not available.
Amir
Offer
O
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. offeram@012.net.il
Schliamser
Jorge E
JE
Nemer
Samniah
S
Arie
Militianu
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D005260:Female; D006336:Heart Massage / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation / Q000009:adverse effects / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000517:prevention & control*; D016896:Treatment Outcome