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Hemodynamic responses to two defibrillating trapezoidal waveforms

H R Holmes, J D Bourland, W A Tacker

    Medical Instrumentation
    |January 1, 1980
    PubMed
    Summary
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    A long-duration, low-tilt defibrillation waveform is better for restoring circulation after ventricular fibrillation. This study compared different shock types in dogs, finding longer shocks improved hemodynamic recovery.

    Area of Science:

    • Cardiovascular medicine
    • Biomedical engineering
    • Electrophysiology

    Background:

    • Automatic implantable defibrillators (AIDs) are crucial for treating life-threatening ventricular arrhythmias.
    • Optimizing defibrillation waveform parameters is essential for effective cardiac resuscitation and hemodynamic stability.
    • Previous research has explored various shock durations and intensities for external defibrillation.

    Purpose of the Study:

    • To compare postdefibrillation hemodynamic responses between a 2-millisecond (msec) 80% tilt shock and a 10-msec 50% tilt shock.
    • To determine the optimal waveform characteristics for catheter-electrode ventricular defibrillation.
    • To evaluate the impact of different defibrillation waveforms on circulatory restoration.

    Main Methods:

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  • Utilized 18 mongrel dogs, surgically implanted with a defibrillating catheter in the right ventricle.
  • Initiated alternating fibrillation-defibrillation episodes every 15 minutes, using either the 2-msec or 10-msec waveform.
  • Recorded comprehensive hemodynamic data, including heart rate, blood pressure, cardiac output, and ventricular contractility (dP/dt), before and after defibrillation.

    • Main Results:

    • The 10-msec shock, characterized by lower peak current and longer duration, demonstrated superior restoration of circulation compared to the 2-msec shock.
    • Hemodynamic parameters such as cardiac output and blood pressure showed better recovery with the longer-duration waveform.
    • Analysis included heart rate, mean femoral arterial blood pressure, cardiac output, left ventricular dP/dt, right ventricular dP/dt, cardiac power, and ventricular ectopic beats per minute.

    Conclusions:

    • A low-peak-current, long-duration, low-tilt defibrillation waveform is preferable for catheter-electrode ventricular defibrillation.
    • Longer shock durations appear more effective in achieving robust hemodynamic recovery post-defibrillation.
    • Findings suggest a specific waveform characteristic for improved outcomes in automated internal defibrillation therapy.