Electrophysiologic changes induced by external transthoracic countershock

The purpose of this study was to characterize the electrophysiological effects of suprathreshold transthoracic shocks. Dogs were anesthetized and two consecutive shocks (10 joules/gk) were applied one minute apart. Ventricular extrasystoles were observed in six of the 11 dogs tested, A-V block in three, ventricular tachycardia in three, and asystole in one. Forty eight hours later the hearts were removed. Conventional electrophysiological techniques revealed the following: 1) injured cells had loss of resting potential, triangularization of the action potential and depressed upstrokes; 2) the functional refractory period was shortened, with an increase in time dependence; 3) action potential alternans; 4) discrete areas of marked depression of conduction; 5) re-excitation with premature stimulation and 6) histological evidence of sub-epicardial injury. These studies suggest that the application of suprathreshold shocks may induce electrophysiological changes potentially inducing tachyarrhythmias.