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Related Experiment Videos

Strength-duration relationship for human transvenous defibrillation

M R Gold1, S R Shorofsky

  • 1Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, USA. MGold@medicine.ab.umd.edu

Circulation
|December 13, 1997
PubMed
Summary

Understanding electrical defibrillation requires knowing the strength-duration relationship. This study evaluated pulse width effects on transvenous defibrillation efficacy in humans, revealing key insights into optimal waveform design.

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Electrophysiology

Background:

  • The strength-duration relationship, pulse width's effect on defibrillation efficacy, is crucial for understanding defibrillation mechanisms and optimizing waveforms.
  • Previous detailed evaluations of this relationship for human transvenous defibrillation were lacking.

Purpose of the Study:

  • To evaluate the strength-duration relationship for human transvenous defibrillation.
  • To determine the impact of varying pulse durations on defibrillation thresholds.
  • To inform the design of optimal defibrillation waveforms.

Main Methods:

  • Prospective study involving 29 patients undergoing defibrillator implantation.
  • Measurement of defibrillation thresholds using short (2-6 ms) and long (6-18 ms) pulse durations.

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  • Utilized a truncated monophasic pulse from a 150 microF capacitor, with randomized testing order.

    • Main Results:

    • Leading edge voltage at defibrillation threshold decreased exponentially with increasing pulse width, reaching an asymptote by 6 ms (566+/-100 V for 2 ms vs. 451+/-68 V for 6 ms).
    • Defibrillation threshold voltage and stored energy were insensitive to pulse durations longer than 6 ms.
    • Mean current decreased monotonically, with no evidence of a rheobase.

    Conclusions:

    • The strength-duration curve's shape and lack of rheobase current suggest fundamental differences between cardiac stimulation and defibrillation.
    • The relationship between pulse duration and defibrillation threshold voltage/stored energy is accurately modeled by a parallel capacitor-resistor circuit with a 5.3 ms time constant.