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Related Experiment Videos

Transcutaneous T wave shock: a universal method for ventricular fibrillation induction

C D Mazer1, M B Greene, P S Misale

  • 1Department of Anesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada.

Pacing and Clinical Electrophysiology : PACE
|February 10, 1998
PubMed
Summary

A new noninvasive method reliably induces ventricular fibrillation (VF) for implantable cardioverter-defibrillator (ICD) testing. This technique, using an external pacemaker and defibrillator, is more successful during ventricular pacing than in native rhythms.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Implantable cardioverter-defibrillators (ICDs) require ventricular fibrillation (VF) induction for testing.
  • Conventional methods for VF induction can be unreliable.
  • Existing ICDs may use low-energy T-wave shocks for VF induction.

Purpose of the Study:

  • To develop a universal, noninvasive method for reliable VF induction.
  • To test the efficacy of an external dual-chamber pacemaker and defibrillator system for VF induction.
  • To compare VF induction success rates in native rhythms versus during ventricular pacing.

Main Methods:

  • A surface ECG signal was fed into the atrial channel of an external DDD pacemaker.
  • The 'AV' delay was adjusted to synchronize the pacemaker's ventricular output with an external defibrillator (5-50 J).

Related Experiment Videos

  • VF was induced in 26 patients during native rhythm (sinus rhythm/atrial fibrillation) or ventricular pacing trains.

    • Main Results:

    • VF induction was successful in 56% of patients in native rhythm and 94% during pacing (P=0.013).
    • VF induction success rates were 36% in native rhythm and 88% during pacing (P<0.001).
    • The R-to-shock interval and energy delivered were comparable between native rhythm and pacing conditions.

    Conclusions:

    • Synchronizing an external defibrillator shock to the T-wave provides a fast and effective method for VF induction.
    • This noninvasive technique ensures reliable arrhythmia induction for any ICD system during implant or follow-up.
    • VF induction is significantly more successful when performed during ventricular pacing compared to native rhythms.