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A Percutaneous Catheter-Based System for the Measurement of Potential Gradients Applicable to the Study of Transthoracic Defibrillation

Authors

  • JOHN P. ROSBOROUGH Ph.D.,

    1. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
    2. Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
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  • D. CURTIS DENO M.D., Ph.D.,

    1. St. Jude Medical, Atrial Fibrillation Division, St. Paul, Minnesota
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  • ROBERT G. WALKER B.A.,

    1. Medtronic Emergency Response Systems, Redmond, Washington
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  • JAMES T. NIEMANN M.D.

    1. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
    2. Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
    3. David Geffen School of Medicine at UCLA, Los Angeles, California
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Address for reprints: James T. Niemann, M.D., Harbor-UCLA Medical Center, Department of Emergency Medicine, 1000 West Carson Street, Box no. 21, Torrance, CA 90509. Tel.: 310-222-6742; Fax: 310-782-1763; e-mail: jniemann@emedharbor.edu

Abstract

Background: The local electric (E) field or potential gradient produced by a shock reliably predicts VF termination. In this study we evaluated a multiple electrode, catheter-based device for closed-chest 3D measurements of E field from transthoracic defibrillation shocks.

Methods: Catheters with multiple electrodes on the tip were placed in intracardiac locations in anesthetized swine. An empirically derived calibration matrix and custom microprocessor was used to transform simultaneously measured voltages into orthogonal E field vector components. E fields produced in six intracardiac locations by 30 and 300 J shocks were compared in eight animals. Correlations were determined for measured current and E field at various shock strengths at two different transthoracic impedances in five additional animals. VF was induced in 12 animals and E field measured during defibrillation attempts.

Results: The E field measurements resulting for 30 J transthoracic shocks were not significantly different among different intracardiac sites. At 300 J, however, significant differences were observed between sites with the greatest intensities recorded in the coronary sinus and right ventricle. Within animals, the variability of the measurement at each site was small, ranging from 2.8 ± 1.6% to 5.7 ± 4.5%. Significant correlations (P < 0.001) between measured E field and peak current were observed at native impedance (34 ± 4 Ω, r = 0.81) and at adjusted impedance (76 ± 4 Ω, r = 0.78) with transthoracic shocks of 200, 300, and 360 J. In VF studies, the probability of defibrillation was closely fit by a sigmoidal dose response curve in the coronary sinus E field with an approximate threshold of 4.7 V/cm with 50% defibrillation success at 9.3 V/cm.

Conclusions: The measured intracardiac E field variability within animals and at a specific site was small, exhibiting a median value of 5.1%, contrasted to median variabilities across animals of 5–11% suggesting the capacity of this measurement system to provide subject specific information on the distribution of E fields. The measured E field magnitudes across animals in the coronary sinus were linearly correlated with applied shock current with a very strong linear relation to effective shock voltage observed in vitro in a saline tank. When evaluated as a predictor of shock success, the observed values were consistent with previously reported critical fields. This technique may be of value in evaluating waveforms for transthoracic defibrillation as well as electrode size, placement, and composition.

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