Experimental evidence of improved transthoracic defibrillation with electroporation-enhancing pulses.

TitleExperimental evidence of improved transthoracic defibrillation with electroporation-enhancing pulses.
Publication TypeJournal Article
Year of Publication2006
AuthorsMalkin RA, Guan D, Wikswo JP
JournalIeee Transactions on Bio Medical Engineering
Volume53
Start Page1901
Issue10
Pagination1901 - 1910
Date Published10/2006
Abstract

There is considerable work on defibrillation wave form optimization. This paper determines the impedance changes during defibrillation, then uses that information to derive the optimum defibrillation wave form.<h4>Methods part i</h4>Twelve guinea pigs and six swine were used to measure the current wave form for square voltage pulses of a strength which would defibrillate about 50% of the time. In guinea pigs, electrodes were placed thoracically, abdominally and subcutaneously using two electrode materials (zinc and steel) and two electrode pastes (Core-gel and metallic paste).<h4>Results part i</h4>The measured current wave form indicated an exponentially increasing conductance over the first 3 ms, consistent with enhanced electroporation or another mechanism of time-dependent conductance. We fit this current with a parallel conductance composed of a time-independent component (g0 = 1.22 +/- 0.28 mS) and a time-dependent component described by g delta (1-e(-t/tau)), where g delta = 0.95 +/- 0.20 mS and tau = 0.82 +/- 0.17 ms in guinea pigs using zinc and Cor-gel. Different electrode placements and materials had no significant effect on this fit. From our fit, we determined the stimulating wave form that would theoretically charge the myocardial membrane to a given threshold using the least energy from the defibrillator. The solution was a very short, high voltage pulse followed immediately by a truncated ascending exponential tail.<h4>Methods part ii</h4>The optimized wave forms and similar nonoptimized wave forms were tested for efficacy in 25 additional guinea pigs and six additional swine using methods similar to Part I.<h4>Results part ii</h4>Optimized wave forms were significantly more efficacious than similar nonoptimized wave forms. In swine, a wave form with the short pulse was 41% effective while the same wave form without the short pulse was 8.3% effective (p < 0.03) despite there being only a small difference in energy (111 J versus 116 CONCLUSIONS: We conclude that a short pulse preceding a defibrillation pulse significantly improves efficacy, perhaps by enhancing electroporation.

DOI10.1109/tbme.2006.881787
Short TitleIeee Transactions on Bio Medical Engineering