Effects of paddle placement and size on defibrillation current distribution: a three-dimensional finite element model

A realistic three-dimensional finite element model of the conductive anatomy of a canine thorax was constructed for use in the study of transthoracic electrical defibrillation. The model was constructed from a series of 21 cross-sectional CT scans of a 14.5 kg beagle, each separated by 0.82 cm. The electrical conductive properties of 8 distinct tissues were incorporated, including the anisotropic properties of skeletal muscle. Current density distributions were obtained for six paddle pairings and two paddle sizes. A quantitative basis for comparing the resulting distributions was formulated. Our results suggest that placing one or both of the paddles near the heart delivers a higher fraction of current to the heart. However, such paddle placements also produce a less uniform myocardial current density distribution and thus have a higher potential for causing damage. We found that some paddle positions can produce myocardial current densities close to the threshold for damage in successful defibrillations. Results obtained for 8 and 12 cm paddles indicate that 12 cm paddles may offer modest advantages over 8 cm paddles in clinical defibrillation. Comparison of our results to available in vivo experimental data confirm the validity of the finite element method for examining continuum field variables pertinent to electrical defibrillation.