A prospective evaluation of two defibrillation safety margin techniques in patients with low defibrillation energy requirements

S. Adam Strickberger*, K. Ching Man, Joseph Souza, Adam Zivin, Raul Weiss, Bradley P. Knight, Rajiva Goyal, Emile G. Daoud, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Introduction: In patients undergoing defibrillator implantation, an appropriate defibrillation safety margin has been considered to be either 10 J or an energy equal to the defibrillation energy requirement. However, a previous clinical report suggested that a larger safety margin may be required in patients with a low defibrillation energy requirement. Therefore, the purpose of this prospective study was to compare the defibrillation efficacy of the two safety margin techniques in patients with a low defibrillation energy requirement. Methods and Results: Sixty patients who underwent implantation of a defibrillator and who had a low defibrillation energy requirement (≤ 6 J) underwent six separate inductions of ventricular fibrillation, at least 5 minutes apart. For each of the first three inductions of ventricular fibrillation, the first two shocks were equal to either the defibrillation energy requirement plus 10 J (14.6 ± 1.0 J), or to twice the defibrillation energy requirement (9.9 ± 2.3 J). The alternate technique was used for the subsequent three inductions of ventricular fibrillation. For each induction of ventricular fibrillation, the first shock success rate was 99.5% ± 4.3% for shocks using the defibrillation energy requirement plus 10 J, compared to 95.0% ± 17.2% for shocks at twice the defibrillation energy requirement (P = 0.02). The charge time (P < 0.0001) and the total duration of ventricular fibrillation (P < 0.0001) were each approximately 1 second longer with the defibrillation energy requirement plus 10 J technique. Conclusion: This study is the first to compare prospectively the defibrillation efficacy of two defibrillation safety margins. In patients with a defibrillation energy requirement ≤ 6 J, a higher rate of successful defibrillation is achieved with a safety margin of 10 J than with a safety margin equal to the defibrillation energy requirement.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalJournal of cardiovascular electrophysiology
Volume9
Issue number1
DOIs
StatePublished - 1998

Keywords

  • Implantable cardioverter defibrillator
  • Probability of defibrillation
  • Ventricular defibrillation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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