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Effect of transthoracic shocks on left ventricular function.

Kenneth M Stein1, Richard B Devereux, Rebecca T Hahn

  • 1Maurice & Corinne Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA. kstein@mail.med.cornell.edu

Resuscitation
|August 13, 2005
PubMed
Summary

High-energy defibrillation shocks do not consistently impair left ventricular function in cardiomyopathy patients. However, effects vary, with some experiencing significant cardiac output reduction after repetitive transthoracic shocks.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Critical Care Medicine

Background:

  • Defibrillation shocks are known to transiently depress ventricular function.
  • The independent effects of high-strength shocks on cardiac function, separate from pre-shock metabolic changes, remain under-assessed in humans.

Purpose of the Study:

  • To systematically evaluate the independent effects of synchronized, high-strength transthoracic shocks on left ventricular function in patients with cardiomyopathy.

Main Methods:

  • Eleven patients with depressed left ventricular function received three consecutive synchronized monophasic transthoracic shocks (200, 200, 360 J) at 60-second intervals during sinus rhythm.
  • Left ventricular chamber size and function were assessed using transesophageal echocardiography.

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Main Results:

  • On average, shocks did not significantly alter hemodynamics, including stroke volume, cardiac output, left ventricular ejection fraction, or regional wall thickening (p>0.05).
  • A significant inter-individual variability was observed; 36% of patients experienced a >25% reduction in cardiac output by the final shock.
  • A trend towards worsening wall thickening in well-functioning segments was offset by improved thickening in poorly functioning segments (p=0.05).

Conclusions:

  • Repetitive, high-strength transthoracic shocks do not consistently impair left ventricular function in patients with cardiomyopathy.
  • The cardiac response to these shocks is highly variable, and significant, potentially important, depression of left ventricular function can occur in a subset of patients.