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Morphologic effects of defibrillation: a preliminary report.

S B Karch, M E Billingham

    Critical Care Medicine
    |October 1, 1984
    PubMed
    Summary

    Repeated direct current (DC) countershocks can cause significant heart damage, including cell death and hemorrhage. Pathological myocyte contraction, seen in animals after defibrillation, was observed in a human patient, suggesting clinical importance.

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    Area of Science:

    • Cardiovascular pathology
    • Electrophysiology
    • Medical device research

    Background:

    • Direct current (DC) countershocks are a critical intervention for cardiac arrhythmias.
    • The potential for cumulative cardiac damage from repeated defibrillation is not fully understood.
    • Previous studies have documented myocardial injury in experimental animals following defibrillation.

    Observation:

    • A 72-year-old male patient received over 300 DC countershocks within two weeks.
    • Morphological examination revealed subepicardial coagulation necrosis and hemorrhage.
    • Pathological contraction of myocytes was observed, a finding previously noted only in animal models.

    Findings:

    • The patient's heart exhibited significant structural changes post-defibrillation.

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  • Coagulative necrosis and hemorrhage indicate acute myocardial injury.
  • Myocyte contraction, a novel finding in humans, suggests a direct effect of electrical energy on cardiac muscle.

    • Implications:

    • These findings highlight the potential for substantial cardiac morbidity associated with frequent defibrillation.
    • The observed myocyte contraction in humans warrants further investigation into its mechanism and clinical significance.
    • Clinicians should consider the cumulative effects of DC countershocks when managing patients with refractory arrhythmias.