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  • Title: Bidirectional transvenous/subcutaneous defibrillation of ventricular fibrillation in dogs: success rates, energy requirements, currents, voltages and impedance.
    Author: Budde T, Vukmirovic NB, Soriano-Romero JM, Abu-Ghazaleh S, Borggrefe M, Schmiel FK, Pölitz B, Arnold G, Breithardt G.
    Journal: Eur Heart J; 1988 Jan; 9(1):92-101. PubMed ID: 3345775.
    Abstract:
    Four hundred and thirteen defibrillations of alternating current-induced ventricular fibrillation were performed in 10 halothane-anaesthetized dogs (body weight: 24.5-30.5 kg). Success rates, energy demands, currents, peak voltages and impedance were determined. A transvenous catheter electrode system (Medtronic 6880, right ventricular apex and superior vena cava, distance 100 or 150 mm) and subcutaneous patch electrodes (Intec 67 L, 2nd/3rd and/or 3rd/4th left intercostal space) were used for bidirectional defibrillation. Loading voltages ranged from 600 to 850 V. With an electrode distance of 100 mm and a pulse duration of 2 ms separated by 1 ms, success rates were 100%, 40% and 0% for 850.650 and 600 V, respectively. With a 3-ms pulse duration, the corresponding rates were 100%, 60% and 50%. With a 2-ms pulse duration, successful defibrillation was achieved with energies lower than 15 J in 27%, with energies between 15 and 20 J in 77%, and 100% with energies higher than 20 J. Defibrillation currents were 4.4-9.3 A for pulse 1 (superior vena cava/ventricular apex) and 6.3-13.4 A for pulse 2 (patch/ventricular apex), respectively. Effective peak voltages ranged from 510 to 787 V and from 514 to 777V and averaged 89.6% of the loading voltages. Impedance values (peak voltage/current) were 75.5-117.7 (pulse 1) and 51.7-94.9 Ohms (pulse 2). Fifty consecutive defibrillations in one animal resulted in a decrease of impedance (114.6 to 84.9 Ohms, pulse 1:75.4 to 53.0 Ohms, pulse 2). Defibrillation of ventricular fibrillation can be achieved with acceptably low energies using a bidirectional transvenous/subcutaneous system, avoiding thoracotomy and general anaesthesia for implantation of the defibrillation system.
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