Author + information
- Received February 5, 2019
- Revision received March 19, 2019
- Accepted April 17, 2019
- Published online July 15, 2019.
- Jian Huang, MD, PhDa,
- Richard B. Ruse, BAb,
- Gregory P. Walcott, MDa,
- Silvio Litovsky, MDc,
- Scott J. Bohanan, MSEEb,
- Da-Wei Gong, MD, PhDd and
- Mark W. Kroll, PhDe,f,∗ ()
- aDivision of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- bRuse Technologies, LLC, Atlanta, Georgia
- cDepartment of Medicine, Department of Pathology, University of Alabama at Birmingham, Alabama
- dSchool of Medicine, University of Maryland, Baltimore, Maryland
- eDepartment of Biomedical Engineering, University of Minnesota Crystal Bay, Minnesota
- fDepartment of Biomedical Engineering, California Polytechnical University, San Luis Obispo, California
- ↵∗Address for correspondence:
Dr. Mark W. Kroll, Biomedical Engineering, University of Minnesota, Box 23, Minneapolis, Minnesota 55455.
Objectives This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model.
Background Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival.
Methods An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J)
Results The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock.
Conclusions Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.
This research was supported by funding from a Medtronic scientific research grant. Mr. Ruse is the principal of Ruse Technologies, and owns patents related to waveform generation. Dr. Kroll has received honoraria from Abbott for speaking. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 5, 2019.
- Revision received March 19, 2019.
- Accepted April 17, 2019.
- 2019 American College of Cardiology Foundation
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