Comparison of alternating current with direct current electroshock across the closed chest

Lown, Bernard; Neuman, J; Amarasingham, R; Berkovits, Barouh V.

doi:10.1016/0002-9149(62)90299-0

Cited by 284 publications

(57 citation statements)

References 16 publications

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“…Since quinidine was used as the antiarrhythmic drug in all of these studies, the observations on circulatory function were necessarily made days to weeks after the instant of reversion, i.e., at a time when over-all circulatory adjustments to the rhythm change would be anticipated. The technique of direct-current transthoracic shock, timed to occur during maximal ventricular depolarization, has been shown by Lown, Neuman, Amarasingham, and Berkovits in animals and man (8,9) to be safe and effective in terminating various arrhythmias; furthermore, it has made possible hemodynamic studies predictably timed to coincide with a change in cardiac rhythm in the absence of quinidine. We have made observations before, during, and after condenser-discharge shocks in 26 patients with various arrhythmias undergoing electrical conversion attempts.…”

mentioning

confidence: 99%

Circulatory Consequences of Changes in Cardiac Rhythm Produced in Patients by Transthoracic Direct-Current Shock*

Graettinger¹,

Carleton²,

Muenster³

1964

J. Clin. Invest.

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Most arrhythmias have long been regarded as undesirable. The salutary clinical consequences of abolishing ventricular and atrial tachycardias are often immediately apparent, and, in general, the circulatory disadvantages of an inappropriately rapid ventricular rate in man would seem well accepted.The effect on the circulation of atrial arrhythmias without tachycardia, particularly atrial fibrillation, however, is not clear. Lower cardiac outputs have been reported in groups of patients with rheumatic heart disease and atrial fibrillation than in those with sinus rhythm (1, 2). Studies of the same patients first with atrial fibrillation and later in sinus rhythm after quinidine conversion have been reported by several investigators (3-7). Of the 35 patients in two of these studies in which only mean data are presented (4, 7), the majority of patients had increased outputs after conversion. Of the 27 patients in the other three studies (3, 5, 6), the output was increased at rest after conversion in eighteen and was unchanged or less in nine. In the two studies in which heart rates were available (4, 5), no rates of over 100 in atrial fibrillation were found. In published data, therefore, it is evident that restoration of sinus rhythm with quinidine does not regularly result in an increased cardiac output when measurements are made days to weeks after conversion.* Submitted for publication June 10, 1964; accepted August 7, 1964. Supported in part by grants from the U. S. Public Health Service, National Institutes of Health (HE-05579), and from the Chicago and Illinois Heart Associations.Presented in part at the 55th annual meeting of the American Society for Clinical Investigation, Atlantic City, N. J., April 29, 1963. Since quinidine was used as the antiarrhythmic drug in all of these studies, the observations on circulatory function were necessarily made days to weeks after the instant of reversion, i.e., at a time when over-all circulatory adjustments to the rhythm change would be anticipated. The technique of direct-current transthoracic shock, timed to occur during maximal ventricular depolarization, has been shown by Lown, Neuman, Amarasingham, and Berkovits in animals and man (8,9) to be safe and effective in terminating various arrhythmias; furthermore, it has made possible hemodynamic studies predictably timed to coincide with a change in cardiac rhythm in the absence of quinidine. We have made observations before, during, and after condenser-discharge shocks in 26 patients with various arrhythmias undergoing electrical conversion attempts. The majority of these patients had atrial fibrillation with varying rates of ventricular response; 21 detailed hemodynamiiic studies were made in 20 of these patients in an effort to assess the relative importance of the ventricular rate and the absence of atrial systole on cardiac output.

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mentioning

confidence: 99%

Circulatory Consequences of Changes in Cardiac Rhythm Produced in Patients by Transthoracic Direct-Current Shock*

Graettinger¹,

Carleton²,

Muenster³

1964

J. Clin. Invest.

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“…It is suggested that ventricular fibrillation is more common with low-voltage AC injuries, whereas asystole is seen more often with high-voltage DC injuries. 6 Other electrocardiogram (ECG) abnormalities reported include sinus tachycardia, right bundle branch block, first-degree AV block, non-specific ST-segment changes, QTc prolongation, premature ventricular contractions and ventricular tachycardia. 7,8 The mechanism behind electrically induced cardiac arrest is not entirely clear but patchy areas of myocardial necrosis that serve as arrhythmogenic foci, as well as increased cardiac sodium-potassium pump activity is postulated.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation following electric shock requiring cardioversion

et al. 2016

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Cardiac arrhythmias following electrical injury falls in a minority. Atrial arrhythmias including atrial fibrillation secondary to electrical shock are even more uncommon. This is a case report of AF requiring pharmacological cardioversion on a 41 year old female following an electrical shock. Initial attempt of electrical cardioversion had failed. Successful pharmacological cardioversion was achieved after 6 hours of amiodarone infusion (12-13 hours after the electric shock). Baseline electrocardiography showed normal pattern post cardioversion. Serum cardiac specific markers, electrolytes, thyroid function, chest x-ray and echocardiographic reports were all within normal limits.

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“…Ventricular fibrillation was common with low-voltage alternating current and asystole was in shocks from high-voltage one [12] [13].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Injury after Electric Accident: Dynamic Change of Cardiac Biomarkers Was the Important Key for Diagnosis of This Serious Complication

Hung¹,

Tien²

2015

JBM

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This report was aimed to record the value of dynamic change of cardiac biomarkers in diagnosis of serious myocardial injury in electrical shock. One female patient was admitted to the emergency department, Cho Ray-Phnom Penh Hospital, Phnom Penh, Cambodia after electrical accident, in cardiopulmonary arrest status with no pulse, no breath. The cardiopulmonary resuscitation was done immediately as intra-tracheal ventilation, fluid replacement with NaCl 0.9%, urine alkalinization therapy with Natribicarbonate 4.2%, sympathomimetic agents as adrenaline and nor-adrenaline, and IV nutrition with glucose 30%. Cardiac biomarkers were repeated many times over 12 hours after admission. Troponin I increased 1000 times higher from 0.02 ng/mL on admission to 20.1 ng/mL within 12 hours. CK-MB increased from 55.4 to 227 U/L after 2 hours (normal value: <16 U/L). CPK (normal value: 90 -140 U/L) changed quickly from 99 U/L on admission to a very high level as 9681 U/L after 12 hrs. The CK-MB/CPK index (defined as CK-MB × 100/CPK, unit as %) changed from 55.9% to 2.7%, respectively by time. In conclusion, the very quick dynamic change of cardiac biomarkers suggested the presence of serious myocardial injury among multiple organs injured in electric shock.

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Comparison of alternating current with direct current electroshock across the closed chest

Cited by 284 publications

References 16 publications

Circulatory Consequences of Changes in Cardiac Rhythm Produced in Patients by Transthoracic Direct-Current Shock*

Circulatory Consequences of Changes in Cardiac Rhythm Produced in Patients by Transthoracic Direct-Current Shock*

Atrial fibrillation following electric shock requiring cardioversion

Myocardial Injury after Electric Accident: Dynamic Change of Cardiac Biomarkers Was the Important Key for Diagnosis of This Serious Complication

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