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Current-based versus energy-based ventricular defibrillation: a prospective study.

B B Lerman1, J P DiMarco, D E Haines

  • 1Department of Medicine, University of Virgina Medical Center, Charlottesville 22908.

Journal of the American College of Cardiology
|November 1, 1988
PubMed
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A new current-based defibrillation method uses less energy and lower peak current than the standard energy-based method, achieving equivalent efficacy rates for ventricular fibrillation patients. This approach may improve defibrillation outcomes.

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrical Engineering

Background:

  • Current defibrillation methods rely on delivering a set energy dose, regardless of individual patient factors.
  • The underlying mechanism of defibrillation is believed to involve a depolarizing current, yet energy delivery remains the standard approach.

Purpose of the Study:

  • To test the hypothesis that a current-based defibrillation method is as effective as an energy-based method but delivers less energy and lower peak current.
  • To compare the efficacy and energy/current delivery of current-based versus energy-based defibrillation for ventricular fibrillation.

Main Methods:

  • A prospective study involving 86 consecutive patients with ventricular fibrillation.
  • Patients were randomized to receive either a current-based (Method 1: 25, 25, 40 A) or an energy-based (Method 2: 200, 200, 360 J) defibrillation protocol.

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  • Patient characteristics, including transthoracic impedance, were similar between groups.

    • Main Results:

    • Both methods demonstrated statistically equivalent first shock (79% vs. 81%) and cumulative shock success rates.
    • The current-based method delivered significantly less mean first shock energy (120 J vs. 200 J) and mean peak current (24 A vs. 33 A).
    • High transthoracic impedance predicted first shock failure exclusively in the energy-based group.

    Conclusions:

    • A current-based defibrillation strategy can achieve equivalent efficacy to the standard energy-based method while significantly reducing energy and peak current delivery.
    • This current-based approach may offer a more efficient and potentially safer alternative for defibrillation, especially in patients with high transthoracic impedance.