Circulation, Vol 73, 1022-1028, Copyright © 1986 by American Heart Association
PS Chen, N Shibata, EG Dixon, RO Martin and RE Ideker
To examine the relationship between the defibrillation threshold and the
strength of shocks that induce ventricular fibrillation during the
vulnerable period, we determined the defibrillation threshold in 22
open-chest dogs using epicardial defibrillation electrodes with the cathode
at the ventricular apex and the anode at the right atrium. We also
determined whether there was an upper limit of shock strength that induces
fibrillation in the vulnerable period by giving shocks of various energy
through these same electrodes during the repolarization phase of paced
rhythm. The above determinations were also made with the anode at the
ventricular apex and the cathode at the right atrium in eight of the dogs
and with the cathode at the ventricular apex and the anode at the left
atrium in another eight of the dogs. In all dogs for all electrode
configurations, there was an upper limit to the shock strength that induced
ventricular fibrillation during the vulnerable period. Depending on the
electrode combination, this upper limit of ventricular vulnerability either
was not significantly different from or was slightly lower than the
defibrillation threshold. The correlation coefficient between the two was
highly significant for all three electrode configurations. These results
support the hypothesis that successful defibrillation with epicardial
electrodes requires a shock strength that reaches or exceeds the upper
limit of ventricular vulnerability and that shocks slightly lower than the
defibrillation threshold fail because they reinitiate ventricular
fibrillation by stimulating portions of the myocardium during their
vulnerable period.
ARTICLES
Comparison of the defibrillation threshold and the upper limit of ventricular vulnerability
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