Control of high common mode voltage during transthoracic defibrillation

A high common mode voltage (Vcm) relative to earth ground is produced on the myocardium during the delivery of a defibrillator pulse and can generate a differential error signal when potential gradients are recorded with bipolar electrodes and isolation amplifiers. The error signal is proportional to Vcm, and therefore, a reduction in Vcm improves the accuracy of the potential gradient data. Experiments were conducted on 5 dogs to determine whether Vcm can be controlled using a bridge circuit. The bridge circuit consisted of a 5 k omega power rheostat in parallel with the transthoracic resistance of the dog. The variable contact of the rheostat was connected to earth ground, and by adjusting the rheostat, Vcm on the myocardium could be varied. In each dog, 20 A shocks were delivered through stainless steel transthoracic electrodes. Point contact electrodes sutured to the epicardium were used to measure Vcm. It was determined that Vcm could be reduced to approximately zero at a given electrode on the heart. In addition, for the 5 dogs studied, the maximum measured Vcm on the heart was only 10% of the transthoracic voltage when the bridge circuit was balanced for an interior point in the heart.