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Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model
Clinical studies show that polarity reversal affects defibrillation success in transvenous monophasic defibrillators. Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In...
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Published in: | Pacing and clinical electrophysiology 1998-07, Vol.21 (7), p.1435-1441 |
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creator | Stellbrink, C Schauerte, P Loeser, H Rosenbaum, C Kuckertz, E Vogel, M Messmer, B J Hanrath, P Schoendube, F A |
description | Clinical studies show that polarity reversal affects defibrillation success in transvenous monophasic defibrillators. Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In nine anesthetized, ventilated pigs, the defibrillation efficacy of biphasic shocks (14.3 ms and 10.8 ms pulse duration) with "initial polarity" (IP, distal electrode = cathode) and "reversed polarity" (RP, distal electrode = anode) delivered via a transvenous/subcutaneous lead system was compared. Voltage and current of each defibrillating pulse were recorded on an oscilloscope and impedance calculated as voltage divided by current. Cumulative defibrillation success was significantly higher for RP than for IP for both pulse durations (55% vs 44%, P = 0.019) for 14.3 ms (57% vs 45%, P < 0.05) and insignificantly higher for 10.8 ms (52% vs 42%, P = ns). Impedance was significantly lower with RP at the trailing edge of pulse 1 (IP: 44 +/- 8.4 vs RP: 37 +/- 9.3 with 14.3 ms, P < 0.001 and IP: 44 +/- 6.2 vs RP: 41 +/- 7.6 omega with 10.8 ms, P < 0.001) and the leading edge of pulse 2 (IP: 37 +/- 5 vs RP: 35 +/- 4.2 omega with 14.3 ms, P = 0.05 and IP: 37.5 +/- 3.7 vs RP: 36 +/- 5 omega with 10.8 ms, P = 0.02). In conclusion, in this animal model, internal defibrillation using the distal coil as anode results in higher defibrillation efficacy than using the distal coil as cathode. Calculated impedances show different courses throughout the shock pulses suggesting differences in current flow during the shock. |
doi_str_mv | 10.1111/j.1540-8159.1998.tb00215.x |
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Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In nine anesthetized, ventilated pigs, the defibrillation efficacy of biphasic shocks (14.3 ms and 10.8 ms pulse duration) with "initial polarity" (IP, distal electrode = cathode) and "reversed polarity" (RP, distal electrode = anode) delivered via a transvenous/subcutaneous lead system was compared. Voltage and current of each defibrillating pulse were recorded on an oscilloscope and impedance calculated as voltage divided by current. Cumulative defibrillation success was significantly higher for RP than for IP for both pulse durations (55% vs 44%, P = 0.019) for 14.3 ms (57% vs 45%, P < 0.05) and insignificantly higher for 10.8 ms (52% vs 42%, P = ns). Impedance was significantly lower with RP at the trailing edge of pulse 1 (IP: 44 +/- 8.4 vs RP: 37 +/- 9.3 with 14.3 ms, P < 0.001 and IP: 44 +/- 6.2 vs RP: 41 +/- 7.6 omega with 10.8 ms, P < 0.001) and the leading edge of pulse 2 (IP: 37 +/- 5 vs RP: 35 +/- 4.2 omega with 14.3 ms, P = 0.05 and IP: 37.5 +/- 3.7 vs RP: 36 +/- 5 omega with 10.8 ms, P = 0.02). In conclusion, in this animal model, internal defibrillation using the distal coil as anode results in higher defibrillation efficacy than using the distal coil as cathode. Calculated impedances show different courses throughout the shock pulses suggesting differences in current flow during the shock.</description><identifier>ISSN: 0147-8389</identifier><identifier>DOI: 10.1111/j.1540-8159.1998.tb00215.x</identifier><identifier>PMID: 9670188</identifier><language>eng</language><publisher>United States</publisher><subject>Animals ; Defibrillators, Implantable ; Electric Countershock - methods ; Electric Impedance ; Electrodes, Implanted ; Equipment Design ; Swine</subject><ispartof>Pacing and clinical electrophysiology, 1998-07, Vol.21 (7), p.1435-1441</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9670188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stellbrink, C</creatorcontrib><creatorcontrib>Schauerte, P</creatorcontrib><creatorcontrib>Loeser, H</creatorcontrib><creatorcontrib>Rosenbaum, C</creatorcontrib><creatorcontrib>Kuckertz, E</creatorcontrib><creatorcontrib>Vogel, M</creatorcontrib><creatorcontrib>Messmer, B J</creatorcontrib><creatorcontrib>Hanrath, P</creatorcontrib><creatorcontrib>Schoendube, F A</creatorcontrib><title>Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Clinical studies show that polarity reversal affects defibrillation success in transvenous monophasic defibrillators. Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In nine anesthetized, ventilated pigs, the defibrillation efficacy of biphasic shocks (14.3 ms and 10.8 ms pulse duration) with "initial polarity" (IP, distal electrode = cathode) and "reversed polarity" (RP, distal electrode = anode) delivered via a transvenous/subcutaneous lead system was compared. Voltage and current of each defibrillating pulse were recorded on an oscilloscope and impedance calculated as voltage divided by current. Cumulative defibrillation success was significantly higher for RP than for IP for both pulse durations (55% vs 44%, P = 0.019) for 14.3 ms (57% vs 45%, P < 0.05) and insignificantly higher for 10.8 ms (52% vs 42%, P = ns). Impedance was significantly lower with RP at the trailing edge of pulse 1 (IP: 44 +/- 8.4 vs RP: 37 +/- 9.3 with 14.3 ms, P < 0.001 and IP: 44 +/- 6.2 vs RP: 41 +/- 7.6 omega with 10.8 ms, P < 0.001) and the leading edge of pulse 2 (IP: 37 +/- 5 vs RP: 35 +/- 4.2 omega with 14.3 ms, P = 0.05 and IP: 37.5 +/- 3.7 vs RP: 36 +/- 5 omega with 10.8 ms, P = 0.02). In conclusion, in this animal model, internal defibrillation using the distal coil as anode results in higher defibrillation efficacy than using the distal coil as cathode. Calculated impedances show different courses throughout the shock pulses suggesting differences in current flow during the shock.</description><subject>Animals</subject><subject>Defibrillators, Implantable</subject><subject>Electric Countershock - methods</subject><subject>Electric Impedance</subject><subject>Electrodes, Implanted</subject><subject>Equipment Design</subject><subject>Swine</subject><issn>0147-8389</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><recordid>eNpNkMtOwzAQRb0A8Sh8ApLFgl2CHceJs0QVj0qV2MC6cpyJakjs4HEK_RZ-Fgu6YDajOzpz52oIueYs56lu33IuS5YpLpucN43KY8tYwWX-dUTOGC_rTAnVnJJzxDfGWMVKeUJOmqpmXKkz8r1y_TCDM0B9Tyc_6GDjngbYQUA9UO9oB71tgx0GHW2SOBsDiPTTxi1t7bTVaA3FrTfvSLXrqKYxaIc7cH7GW5xbM0ftIIn_Vj5Q3GOEkVqXViYfjHWQDOyYzo6-g-GCHPd6QLg89AV5fbh_WT5l6-fH1fJunU0Fq2Km-6rkUkgOWnXC1MyoquhkZUrd9lDyvhV1YqCpRZ9mQpjCyLLh0hR10QIXC3Lz5zsF_zEDxs1o0UBK-Zt6oxjjtSqLBF4dwLkdodtMIYUN-83hm-IH8R58tQ</recordid><startdate>19980701</startdate><enddate>19980701</enddate><creator>Stellbrink, C</creator><creator>Schauerte, P</creator><creator>Loeser, H</creator><creator>Rosenbaum, C</creator><creator>Kuckertz, E</creator><creator>Vogel, M</creator><creator>Messmer, B J</creator><creator>Hanrath, P</creator><creator>Schoendube, F A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19980701</creationdate><title>Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model</title><author>Stellbrink, C ; Schauerte, P ; Loeser, H ; Rosenbaum, C ; Kuckertz, E ; Vogel, M ; Messmer, B J ; Hanrath, P ; Schoendube, F A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p206t-af6415351ea8d3c70c862d56c4abfe41fb37af6e973fc4a33c2c54915c272be13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Animals</topic><topic>Defibrillators, Implantable</topic><topic>Electric Countershock - methods</topic><topic>Electric Impedance</topic><topic>Electrodes, Implanted</topic><topic>Equipment Design</topic><topic>Swine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stellbrink, C</creatorcontrib><creatorcontrib>Schauerte, P</creatorcontrib><creatorcontrib>Loeser, H</creatorcontrib><creatorcontrib>Rosenbaum, C</creatorcontrib><creatorcontrib>Kuckertz, E</creatorcontrib><creatorcontrib>Vogel, M</creatorcontrib><creatorcontrib>Messmer, B J</creatorcontrib><creatorcontrib>Hanrath, P</creatorcontrib><creatorcontrib>Schoendube, F A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stellbrink, C</au><au>Schauerte, P</au><au>Loeser, H</au><au>Rosenbaum, C</au><au>Kuckertz, E</au><au>Vogel, M</au><au>Messmer, B J</au><au>Hanrath, P</au><au>Schoendube, F A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>1998-07-01</date><risdate>1998</risdate><volume>21</volume><issue>7</issue><spage>1435</spage><epage>1441</epage><pages>1435-1441</pages><issn>0147-8389</issn><abstract>Clinical studies show that polarity reversal affects defibrillation success in transvenous monophasic defibrillators. Current devices use biphasic shocks for defibrillation. We investigated in a porcine animal model whether polarity reversal influences defibrillation success with biphasic shocks. In nine anesthetized, ventilated pigs, the defibrillation efficacy of biphasic shocks (14.3 ms and 10.8 ms pulse duration) with "initial polarity" (IP, distal electrode = cathode) and "reversed polarity" (RP, distal electrode = anode) delivered via a transvenous/subcutaneous lead system was compared. Voltage and current of each defibrillating pulse were recorded on an oscilloscope and impedance calculated as voltage divided by current. Cumulative defibrillation success was significantly higher for RP than for IP for both pulse durations (55% vs 44%, P = 0.019) for 14.3 ms (57% vs 45%, P < 0.05) and insignificantly higher for 10.8 ms (52% vs 42%, P = ns). Impedance was significantly lower with RP at the trailing edge of pulse 1 (IP: 44 +/- 8.4 vs RP: 37 +/- 9.3 with 14.3 ms, P < 0.001 and IP: 44 +/- 6.2 vs RP: 41 +/- 7.6 omega with 10.8 ms, P < 0.001) and the leading edge of pulse 2 (IP: 37 +/- 5 vs RP: 35 +/- 4.2 omega with 14.3 ms, P = 0.05 and IP: 37.5 +/- 3.7 vs RP: 36 +/- 5 omega with 10.8 ms, P = 0.02). In conclusion, in this animal model, internal defibrillation using the distal coil as anode results in higher defibrillation efficacy than using the distal coil as cathode. Calculated impedances show different courses throughout the shock pulses suggesting differences in current flow during the shock.</abstract><cop>United States</cop><pmid>9670188</pmid><doi>10.1111/j.1540-8159.1998.tb00215.x</doi><tpages>7</tpages></addata></record> |
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subjects | Animals Defibrillators, Implantable Electric Countershock - methods Electric Impedance Electrodes, Implanted Equipment Design Swine |
title | Influence of polarity reversal on defibrillation success with biphasic shocks and a transvenous/subcutaneous defibrillator system in a porcine animal model |
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