The electrical dose for direct ventricular defibrillation in man

The threshold electrical energy for direct ventricular defibrillation was measured in 100 patients whose hypothermic hearts were fibrillated for cardiac operations. In 93 cases 10 joules or less was sufficient, and in 48 of these cases 5 joules or less defibrillated the ventricles. Because a shock of 10 joules defibrillated the heart of most of our patients, we recommend an initial shock of 5 to 10 joules rather than the 20 joules used more commonly. Until the safety margin between defibrillation threshold and damage threshold is established for direct defibrillation, use of shocks with adequate but not excessive strength may avoid unnecessary damage to the myocardium. When hearts refibrillate after defibrillation, it is unnecessary to use higher energy settings for subsequent defibrillation attempts. Instead, an antiarrhythmic drug should be administered and another shock of the same intensity that defibrillated the first time should be applied.