Direct Current Application: Easy Induction of Ventricular Fibrillation for the Determination of the Defibrillation Threshold in Patients with Implantable Cardioverter Defibrillators
Article first published online: 30 JUN 2006
Pacing and Clinical Electrophysiology
Volume 15, Issue 8, pages 1137–1143, August 1992
How to Cite
WEISMÜLLER, P., RICHTER, P., BINNER, L., GROSSMANN, G., HEMMER, W., HÖHER, M., KOCHS, M. and HOMBACH, V. (1992), Direct Current Application: Easy Induction of Ventricular Fibrillation for the Determination of the Defibrillation Threshold in Patients with Implantable Cardioverter Defibrillators. Pacing and Clinical Electrophysiology, 15: 1137–1143. doi: 10.1111/j.1540-8159.1992.tb03116.x
- Issue published online: 30 JUN 2006
- Article first published online: 30 JUN 2006
- Received October 24, 1991; revision February 26, 1992; accepted March 14, 1992.
- implantable Cardioverter defibrillator;
- ventricular fibrillation;
- direct current;
- defibrillation threshold
For the determination of the defibrillation threshold, the induction of ventricular fibrillation is mandatory. However, in severely damaged hearts it is sometimes difficult to induce ventricular fibrillation by rapid stimulation or alternating current. Only rapid nonclinical ventricular tachycardias may result, and their cardioversion threshold may be different from the defibrillation threshold. Therefore, it was the purpose of this study to test the potential of direct current (DC) application to rapidly induce ventricular fibrillation in patients with an implanted Cardioverter defibrillator. The defibrillation threshold had to be determined in 13 patients (9 with coronary heart disease, 4 with dilative cardiomyopathy, ejection fraction 35%) during and 2 weeks after the implantation of a Cardioverter defibrillator. DC was applied 37 times by a commercially available 9-V DC battery via a bipolar catheter for about 3 seconds. Ventricular fibrillation was induced 23 times (62%) and rapid nonclinical ventricular tachycardias were induced six times (16%). In one patient clinical ventricular tachycardia was observed. In seven instances (19%) sinus rhythm remained. In 12 of the 13 patients, ventricular fibrillation could be induced by DC. Thus, the induction of ventricular fibrillation by DC application may serve as an additional tool to induce ventricular fibrillation, determining the defibrillation threshold in implantable Cardioverter defibrillator patients.