Cardiac damage produced by transchest damped sine wave shocks

High-energy transchest damped wave sine defibrillation shocks have been shown to produce cardiac damage when applied in rapid sequence. However, there are no reports as to whether single, threshold-intensity shocks produce damage. In this study, nonfibrillating dogs were subjected either to a single, threshold-intensity (1 A/kg) shock, or to a series of 6 shocks with high intensity (3 to 4.8 A/kg). Electrodes of 8 cm diameter were used to apply the shock through the chest wall. Dogs receiving shocks of adequate (but not excessive) strength to defibrillate showed no cardiac damage, although they exhibited transient ventricular arrhythmias after the shock was applied. All dogs receiving the higher intensity, multiple shocks showed gross and microscopic evidence of cardiac damage. Ventricular lesions were observed in both right and left ventricular free walls and were sometimes transmural in extent. ECG analysis of the records from the dogs receiving multiple, high-intensity shocks showed second and third degree A-V block, ventricular ectopic beats, ventricular tachycardia, S-T segment changes, and T-wave inversion. Although multiple, high-energy, high-current defibrillation shocks produce permanent cardiac damage in dogs, threshold shocks do not produce morphologic changes.