Sequential Shocks are Comparable to Single Shocks Employing Two Current Pathways for Internal Defibrillation in Dogs

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Abstract
Sequential pulse defibrillation using two current pathways was compared with single shocks simultaneously utilizing both pathways in 16 dogs to assess the effects of temporal summation. A cardioverter-defibrillator catheter was positioned via the external jugular vein with the distal 4 cm2 shocking electrode located in the right ventricular apex and the proximal 8 cm2 electrode located in the superior vena cava. Three electrode configurations were tested: (1) single pulse, distal electrode (cathode) to proximal electrode and chest wall patch (common anode), (2) sequential 5 ms pulses with 1 ms interpulse delay, distal electrode (cathode) to proximal electrode (anode) followed by distal electrode (cathode) to chest wall patch (anode), and (3) sequential 10 ms pulses with 1 ms interpulse delay using same current pathways described for configuration 2. The lowest energies resulting in termination of AC induced ventricular fibrillation on four trials were 27.9, 26.6, and 42.3 joules respectively for configurations 1, 2, and 3. The mean energy levels were not significantly different for configurations 1 and 2, both of which were significantly lower than that for configuration 3. The lowest peak voltages terminating ventricular fibrillation on four trials were 595 +/- 176, 521 +/- 134 and 579 +/- 171 volts for configuration 1, 2, and 3. The mean voltage level for configuration 2 was significantly lower than that for configurations 1 and 3, which were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)