Coronary Blood Flow Produced by Muscle Contractions Induced by Intracardiac Electrical CPR during Ventricular Fibrillation

Abstract

Intracardiac applied electrical CPR produced observable skeletal muscle contractions, measurable pressure pulses, and coronary perfusion pressures similar to MCC during a brief episode of untreated VF.

Four-terminal impedance monitoring of cardiac output: an elegant clinical application of a classical engineering trick

“…There have been encouraging results with so-called 'medium voltage' electrical therapies to generate cardiac output in spite of ongoing VF as seen with storm. 6 Medium voltage therapy may show promise for treating pulseless electrical activity (PEA). 7 Since the detection of PEA is not possible with a purely electrogram analysis, the addition of a reliable estimate of cardiac output is required.…”

A case of variant angina treated with a pacemaker for cardiopulmonary arrest due to complete atrioventricular block and pulseless electrical activity

“…Chest compression and epinephrine are effective for PEA, whereas electrical defibrillation is not. Medium voltage therapy (MVT) has recently been attempted, where electrical stimulation by a cardiac device during ventricular fibrillation or PEA induces skeletal muscle contractions and maintains coronary blood flow in the same manner as chest compression [14,15]. Although this technique has not yet been put to practical use, it would appear to be well suited to cases such as the present one.…”

Future of Implantable Devices for Cardiac Rhythm Management

“…Prior experimental studies showed that trains of electric stimulation, called medium-voltage electric therapy, applied via transthoracic or intracardiac electrodes can augment coronary and cerebral perfusion during VF or PEA. 46,47 Although the mechanism remains unclear, it has been proposed that medium-voltage electric therapy causes thoracic (skeletal) and myocardial muscle contractions that promote blood flow much like mechanical chest compression. Two different pulse train protocols have been tested: a very short pulse width of 0.15 milliseconds delivered at 14 pulses per train and a long pulse width of 7.5 milliseconds at 7 pulses per train to induce thoracic (skeletal) and myocardial muscle contractions.…”