Improved internal defibrillation success with shocks timed to the morphology electrogram
A previous retrospective study by our group suggested that shocks timed to the upslope of the shocking lead electrogram improved defibrillation efficacy. The goal of this study was to prospectively determine whether defibrillation threshold could be reduced by use of an algorithm that timed shocks t...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1998-08, Vol.98 (8), p.808-812 |
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| creator | HSU, W YAYUN LIN LANG, D. J JONES, J. L |
| description | A previous retrospective study by our group suggested that shocks timed to the upslope of the shocking lead electrogram improved defibrillation efficacy. The goal of this study was to prospectively determine whether defibrillation threshold could be reduced by use of an algorithm that timed shocks to the upslope of coarse ventricular fibrillation (test treatment) compared with shocks delivered asynchronously after 10 seconds of fibrillation (control treatment).
Ten pigs were instrumented with a 3-lead system for internal defibrillation. Initial estimates of the energy required to achieve defibrillation E50 for both treatments were made by an up/down method. Subsequently, additional shocks at V50+/-10% and V50-20% were given for each treatment to obtain data points at higher and lower intensities. Probability-of-success curves were estimated for both treatments by the best-fit method. Energies required were significantly lower for the timed shocks than for the asynchronous shocks (P |
| doi_str_mv | 10.1161/01.CIR.98.8.808 |
| format | Article |
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Ten pigs were instrumented with a 3-lead system for internal defibrillation. Initial estimates of the energy required to achieve defibrillation E50 for both treatments were made by an up/down method. Subsequently, additional shocks at V50+/-10% and V50-20% were given for each treatment to obtain data points at higher and lower intensities. Probability-of-success curves were estimated for both treatments by the best-fit method. Energies required were significantly lower for the timed shocks than for the asynchronous shocks (P<0.00 1). E80 was reduced 15.5%, from 27.1+/-2.5 to 22.9+/-1.8 J (P<0.002). The width of the probability-of-success curve (E80-E20) for the test treatment was also significantly narrower than that for the control treatment (7.1+/-0.9 versus 10.8+/-1.7, P<0.01). Normalized curve width (E80-E20)/E50 was decreased from 51+/-5% of E50 for control shocks to 37+/-4% of E50 for synchronous shocks (P<0.02).
In this model, defibrillation threshold is lower and more deterministic when shocks are timed to the upslope of the shocking lead electrogram. If a similar reduction is observed in humans, shock timing may lower defibrillation threshold and simplify programming of shock intensity.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.98.8.808</identifier><identifier>PMID: 9727552</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Algorithms ; Animals ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Electric Countershock ; Electrocardiography ; Electrodes ; Heart ; Medical sciences ; Probability ; Prospective Studies ; Swine ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 1998-08, Vol.98 (8), p.808-812</ispartof><rights>1998 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Aug 25, 1998</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c429t-4328807d1a0446cfb8e7f7d72363e817ed206c102b8fbbeeafd3f0adb8aeecfc3</citedby><cites>FETCH-LOGICAL-c429t-4328807d1a0446cfb8e7f7d72363e817ed206c102b8fbbeeafd3f0adb8aeecfc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,3689,27931,27932</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2357980$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9727552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HSU, W</creatorcontrib><creatorcontrib>YAYUN LIN</creatorcontrib><creatorcontrib>LANG, D. J</creatorcontrib><creatorcontrib>JONES, J. L</creatorcontrib><title>Improved internal defibrillation success with shocks timed to the morphology electrogram</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>A previous retrospective study by our group suggested that shocks timed to the upslope of the shocking lead electrogram improved defibrillation efficacy. The goal of this study was to prospectively determine whether defibrillation threshold could be reduced by use of an algorithm that timed shocks to the upslope of coarse ventricular fibrillation (test treatment) compared with shocks delivered asynchronously after 10 seconds of fibrillation (control treatment).
Ten pigs were instrumented with a 3-lead system for internal defibrillation. Initial estimates of the energy required to achieve defibrillation E50 for both treatments were made by an up/down method. Subsequently, additional shocks at V50+/-10% and V50-20% were given for each treatment to obtain data points at higher and lower intensities. Probability-of-success curves were estimated for both treatments by the best-fit method. Energies required were significantly lower for the timed shocks than for the asynchronous shocks (P<0.00 1). E80 was reduced 15.5%, from 27.1+/-2.5 to 22.9+/-1.8 J (P<0.002). The width of the probability-of-success curve (E80-E20) for the test treatment was also significantly narrower than that for the control treatment (7.1+/-0.9 versus 10.8+/-1.7, P<0.01). Normalized curve width (E80-E20)/E50 was decreased from 51+/-5% of E50 for control shocks to 37+/-4% of E50 for synchronous shocks (P<0.02).
In this model, defibrillation threshold is lower and more deterministic when shocks are timed to the upslope of the shocking lead electrogram. If a similar reduction is observed in humans, shock timing may lower defibrillation threshold and simplify programming of shock intensity.</description><subject>Algorithms</subject><subject>Animals</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Electric Countershock</subject><subject>Electrocardiography</subject><subject>Electrodes</subject><subject>Heart</subject><subject>Medical sciences</subject><subject>Probability</subject><subject>Prospective Studies</subject><subject>Swine</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkM1rGzEQxUVocN0055wKopTe1tHH7ko6FtMkhkAhpNCb0GpHtpLdlStpG_zfVyHGhzCHYZjfe8w8hK4oWVHa0mtCV-vNw0rJVSkiz9CSNqyu6oarD2hJCFGV4Ix9RJ9Seipjy0WzQAslmGgatkR_NuM-hn_QYz9liJMZcA_Od9EPg8k-TDjN1kJK-MXnHU67YJ8Tzn4sihxw3gEeQ9zvwhC2BwwD2BzDNprxMzp3ZkhweewX6PfNz8f1XXX_63az_nFf2ZqpXNWcSUlETw2p69a6ToJwoheMtxwkFdAz0lpKWCdd1wEY13NHTN9JA2Cd5Rfo-5tveePvDCnr0ScL5foJwpy04IrVVKoCfn0HPoX59eGkGWWCScp5ga7fIBtDShGc3kc_mnjQlOjXwDWhugSuldSliCyKL0fbuSuhnPhjwmX_7bg3yZrBRTNZn04Y441QkvD_xoyKSg</recordid><startdate>19980825</startdate><enddate>19980825</enddate><creator>HSU, W</creator><creator>YAYUN LIN</creator><creator>LANG, D. J</creator><creator>JONES, J. L</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19980825</creationdate><title>Improved internal defibrillation success with shocks timed to the morphology electrogram</title><author>HSU, W ; YAYUN LIN ; LANG, D. J ; JONES, J. L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c429t-4328807d1a0446cfb8e7f7d72363e817ed206c102b8fbbeeafd3f0adb8aeecfc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Algorithms</topic><topic>Animals</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Electric Countershock</topic><topic>Electrocardiography</topic><topic>Electrodes</topic><topic>Heart</topic><topic>Medical sciences</topic><topic>Probability</topic><topic>Prospective Studies</topic><topic>Swine</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HSU, W</creatorcontrib><creatorcontrib>YAYUN LIN</creatorcontrib><creatorcontrib>LANG, D. J</creatorcontrib><creatorcontrib>JONES, J. L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HSU, W</au><au>YAYUN LIN</au><au>LANG, D. J</au><au>JONES, J. L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved internal defibrillation success with shocks timed to the morphology electrogram</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1998-08-25</date><risdate>1998</risdate><volume>98</volume><issue>8</issue><spage>808</spage><epage>812</epage><pages>808-812</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>A previous retrospective study by our group suggested that shocks timed to the upslope of the shocking lead electrogram improved defibrillation efficacy. The goal of this study was to prospectively determine whether defibrillation threshold could be reduced by use of an algorithm that timed shocks to the upslope of coarse ventricular fibrillation (test treatment) compared with shocks delivered asynchronously after 10 seconds of fibrillation (control treatment).
Ten pigs were instrumented with a 3-lead system for internal defibrillation. Initial estimates of the energy required to achieve defibrillation E50 for both treatments were made by an up/down method. Subsequently, additional shocks at V50+/-10% and V50-20% were given for each treatment to obtain data points at higher and lower intensities. Probability-of-success curves were estimated for both treatments by the best-fit method. Energies required were significantly lower for the timed shocks than for the asynchronous shocks (P<0.00 1). E80 was reduced 15.5%, from 27.1+/-2.5 to 22.9+/-1.8 J (P<0.002). The width of the probability-of-success curve (E80-E20) for the test treatment was also significantly narrower than that for the control treatment (7.1+/-0.9 versus 10.8+/-1.7, P<0.01). Normalized curve width (E80-E20)/E50 was decreased from 51+/-5% of E50 for control shocks to 37+/-4% of E50 for synchronous shocks (P<0.02).
In this model, defibrillation threshold is lower and more deterministic when shocks are timed to the upslope of the shocking lead electrogram. If a similar reduction is observed in humans, shock timing may lower defibrillation threshold and simplify programming of shock intensity.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9727552</pmid><doi>10.1161/01.CIR.98.8.808</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Algorithms Animals Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Electric Countershock Electrocardiography Electrodes Heart Medical sciences Probability Prospective Studies Swine Time Factors Treatment Outcome |
| title | Improved internal defibrillation success with shocks timed to the morphology electrogram |
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