Probability of successful defibrillation at multiples of the defibrillation energy requirement in patients with an implantable defibrillator

S. Adam Strickberger*, Emile G. Daoud, Theresa Davidson, Raul Weiss, Frank Bogun, Bradley P. Knight, Marwan Bahu, Rajiva Goyal, K. Ching Man, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

Background: The probability of successful defibrillation has been determined in normal animals but not in patients undergoing defibrillator implantation. Therefore, the purpose of this prospective study was to determine the probability of successful defibrillation in humans on the basis of a step-down defibrillation energy requirement. Methods and Results: Fifty- three consecutive patients underwent five separate inductions of ventricular fibrillation after the defibrillation energy requirement was determined with the use of small decrements and a step-down protocol (20, 15, 12, 10, 8, 6, 5, 4, 3, 2, 1, and 0.8 J). The first shock energy for defibrillation was either 1.0, 1.3, 1.5, 1.7, or 2.0 times the defibrillation energy requirement, and the likelihoods of successful defibrillation were 70±27%, 84±12%, 86±25%, 80±29%, and 88±32%, respectively (P=.03). The frequencies of uniformly successful defibrillation (5 of 5 defibrillation attempts) were 30%, 27%, 60%, 64%, and 73%, respectively (P=.01). Seven patients in whom the defibrillation energy requirement was <4 J had an overall rate of successful defibrillation of 54±20% compared with 86±20% in the remaining 47 patients (P=.002). The likelihood of successful defibrillation at twice the defibrillation energy requirement was 98% in the 46 patients with a defibrillation energy requirement of >4 J and 67% in the 7 patients with a defibrillation energy requirement of <4 J (P=.I7). An absolute safety margin of 7 J was associated with a 96% probability of successful defibrillation. Conclusions: The probability of successful defibrillation is 70% at the defibrillation energy requirement. The probability plateaus at 88%, at twice the defibrillation energy requirement. A 96% probability of successful defibrillation is achieved at an absolute safety margin of 7 J and a 98% success rate s achieved at energies that are twice the defibrillation energy requirement if the defibrillation energy requirement is >4 J. If the defibrillation energy requirement is <4 J, larger multiples of the defibrillation energy requirement are needed to achieve a high probability of successful defibrillation.

Original languageEnglish (US)
Pages (from-to)1217-1223
Number of pages7
JournalCirculation
Volume96
Issue number4
DOIs
StatePublished - Aug 19 1997

Keywords

  • Arrhythmias
  • Defibrillation
  • Fibrillation
  • Implantable Defibrillator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Strickberger, S. A., Daoud, E. G., Davidson, T., Weiss, R., Bogun, F., Knight, B. P., Bahu, M., Goyal, R., Man, K. C., & Morady, F. (1997). Probability of successful defibrillation at multiples of the defibrillation energy requirement in patients with an implantable defibrillator. Circulation, 96(4), 1217-1223. https://doi.org/10.1161/01.CIR.96.4.1217