title: Prolonged burst as a new method for cardioverter-defibrillator testing.
abstract: OBJECTIVE
  To find out whether it is possible to anaesthetize patients safely without analgesia and sedation, using burst pacing prolonged until the patient becomes unconscious.
  
  
  METHODS
  One hundred and four patients undergoing implantation or reimplantation of a cardioverter-defibrillator were included. Patients randomized into Group B underwent prolonged burst pacing without analgesia and sedation. Patients in Group T underwent a T-wave shock under analgesia and sedation. Blood samples for measurement of serum neuron-specific enolase were taken before surgery and 6, 24, and 48 h after the procedure.
  
  
  RESULTS
  From the 104 patients, 51 were randomly assigned to Group B and 53 to Group T. Four patients from Group B were switched to Group T (ventricular fibrillation not induced by burst pacing). The clinical characteristics of both groups were similar. The mean total time of cardiac arrest was significantly longer in Group B (23.0 ± 4.4 s, median 22.7) vs. Group T (10.3 ± 3.0 s, median 10.0), P < 0.0001 (Mann-Whitney U-test). The effectiveness of both induction methods was similar (92.1% in Group B and 100% in Group T). The mean neuron-specific enolase levels after 6, 24, and 48 h were similar in Groups B and T (13.1 ± 6.3 and 11.6 ± 5.8 mg/L, 14.5 ± 7.5 and 13.4 ± 6.0 mg/L, and 14.9 ± 5.9 and 12.2 ± 6.0 mg/L, respectively) as were these levels compared with baseline neuron-specificenolase levels (14.0 ± 5.9 and 13.4 ± 4.0 mg/L, respectively), P = NS for all.
  
  
  CONCLUSIONS
  Despite a longer time of total cardiac arrest, prolonged burst pacing appears to be a safe and effective method for induction of ventricular fibrillation during cardioverter-defibrillator testing, which enables omission of analgesia and sedation or general anaesthesia.
authors.affiliation: Ist Medical Department-Cardiology,  University Hospital Olomouc, Olomouc,  Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Lukl
authors.forename: Dan
authors.initials: D
authors.lastname: Marek
authors.forename: Alan
authors.initials: A
authors.lastname: Bulava
authors.forename: Marián
authors.initials: M
authors.lastname: Fedorco
authors.forename: Petr
authors.initials: P
authors.lastname: Schneiderka
authors.forename: Milos
authors.initials: M
authors.lastname: Táborsky
authors.forename: Jana
authors.initials: J
authors.lastname: Zapletalová
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D019544:Equipment Failure Analysis / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*