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Dysrhythmias after direct-current cardioversion.

B Waldecker, P Brugada, M Zehender

    The American Journal of Cardiology
    |January 1, 1986
    PubMed
    Summary
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    Direct-current (DC) countershocks effectively treat ventricular tachycardia/fibrillation (VT/VF) and atrial fibrillation (AF). Continuous cardiac rhythm analysis is crucial for automatic devices to manage postshock arrhythmias and ensure patient safety.

    Area of Science:

    • Cardiology
    • Medical Devices
    • Electrophysiology

    Background:

    • Direct-current (DC) countershocks are vital for treating life-threatening arrhythmias like ventricular tachycardia/fibrillation (VT/VF) and atrial fibrillation (AF).
    • The efficacy of DC shocks and the occurrence of postshock arrhythmias are critical considerations for the development of automated external defibrillators (AEDs) and implantable cardioverter-defibrillators (ICDs).

    Purpose of the Study:

    • To analyze the success rates of transchest DC countershocks for induced VT/VF and AF.
    • To investigate the relationship between clinical characteristics, arrhythmia types, and the incidence of postshock arrhythmias.
    • To evaluate the impact of antiarrhythmic drugs on postshock rhythm disturbances.

    Main Methods:

    • Retrospective analysis of 112 DC shock episodes in 99 patients with induced VT/VF or AF.

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  • Correlation of clinical data and arrhythmia characteristics with DC shock success rates and postshock events.
  • Assessment of asystole duration, recurrence of VT/VF, and development of bradyarrhythmias post-shock.

    • Main Results:

    • The first DC shock successfully terminated 80% of VT/VF episodes, with all episodes resolved within four shocks.
    • Asystole duration was significantly longer following VT/VF (1900 ms) compared to AF (1150 ms).
    • VT/VF recurred in 26% of initially successful shocks, and bradyarrhythmias requiring pacing occurred in patients receiving antiarrhythmic drugs.

    Conclusions:

    • Transchest DC countershocks demonstrate high efficacy in terminating VT/VF and AF.
    • Continuous cardiac rhythm monitoring post-discharge is essential for automatic devices to manage unsuccessful shocks or recurrent arrhythmias.
    • Demand pacing capability is desirable in automated devices to address severe bradycardia in patients on antiarrhythmic medications.