[Myocardial lesion secondary to defibrillation. Literature review and practical implications]

A 39 years old patient was defibrillated during the acute stage of an inferior myocardial infarction. He presented an elevation of the ST segment in the right precordial leads immediately after resuscitation. The evolution of the electrocardiographic changes were characterised by the development of a septo-apical subepicardial necrosis, whose sequelae remained nine months after the initial event. In the absence of any stenosing lesion of the anterior interventricular coronary artery, this necrosis can be attributed to the electrical shocks. The close position of the defibrillator paddles on the thorax certainly played a determining role, exposing the underlying myocardial tissue to an excessive electrical intensity. The authors point out the importance of the technical modalities of defibrillation that are likely to ensure the best chances of success with a minimum of secondary myocardial damage.