Predicting the potential gradient field in ventricular fibrillation from shocks delivered in paced rhythm

A method of defibrillation threshold determination that utilizes low-strength shocks delivered in a benign rhythm would be desirable. Because the two-dimensional epicardial potential gradient (PG) is a shock parameter that is linked to defibrillation, we examined whether the epicardial PG measured for shocks delivered in paced rhythm could be used to predict the PG for defibrillation-strength shocks delivered in ventricular fibrillation (VF). In six open-chest pentobarbital-anesthetized pigs with left ventricular apex and right atrial internal defibrillation patches, we measured the epicardial PG field for shocks delivered in paced rhythm and during VF. We determined that there was a linear relationship between epicardial PG and shock strength for shocks delivered in paced rhythm. However, prediction of the PG measured for shocks in VF from those measured in paced rhythm resulted in a statistically significant overestimation of the PG in VF. We conclude that, for equivalent strength shocks, the epicardial PG field is weaker for shocks delivered in VF. This change in the potential gradient field can have an effect on defibrillation threshold estimates that are based on shocks delivered in paced rhythm.