High-Energy Defibrillation Increases the Severity of Postresuscitation Myocardial Dysfunction

Xie, Jierui; Weil, Max Harry; Sun, Shijie; Tang, Wanchun; Sato, Yukihito; Jin, Xiaohua; Bisera, Joe

doi:10.1161/01.cir.96.2.683

Cited by 255 publications

(107 citation statements)

References 34 publications

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“…However, many defibrillation attempts are futile [11,12]. The consequences are longer CPR interruptions to charge the defibrillator and potential damage to the myocardium caused by the shock; both of these factors compromise the survival of the patient [13,14].…”

Section: Introductionmentioning

confidence: 99%

Application of Entropy-Based Features to Predict Defibrillation Outcome in Cardiac Arrest

Chicote

Irusta

Alcaraz

et al. 2016

Entropy

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Prediction of defibrillation success is of vital importance to guide therapy and improve the survival of patients suffering out-of-hospital cardiac arrest (OHCA). Currently, the most efficient methods to predict shock success are based on the analysis of the electrocardiogram (ECG) during ventricular fibrillation (VF), and recent studies suggest the efficacy of waveform indices that characterize the underlying non-linear dynamics of VF. In this study we introduce, adapt and fully characterize six entropy indices for VF shock outcome prediction, based on the classical definitions of entropy to measure the regularity and predictability of a time series. Data from 163 OHCA patients comprising 419 shocks (107 successful) were used, and the performance of the entropy indices was characterized in terms of embedding dimension (m) and matching tolerance (r). Six classical predictors were also assessed as baseline prediction values. The best prediction results were obtained for fuzzy entropy (FuzzEn) with m = 3 and an amplitude-dependent tolerance of r = 80 µV. This resulted in a balanced sensitivity/specificity of 80.4%/76.9%, which improved by over five points the results obtained for the best classical predictor. These results suggest that a FuzzEn approach for a joint quantification of VF amplitude and its non-linear dynamics may be a promising tool to optimize OHCA treatment.

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Section: Introductionmentioning

confidence: 99%

Application of Entropy-Based Features to Predict Defibrillation Outcome in Cardiac Arrest

Chicote

Irusta

Alcaraz

et al. 2016

Entropy

View full text Add to dashboard Cite

show abstract

“…However, previous clinical and pre-clinical studies showed that the ICD shocks may induce myocardial injury and shocks with a higher output can cause more severe myocardial damage than those with a lower output. [13][14][15] If the DFT testing is not performed, it is hard to be convinced that the lower energy output would work effectively. In the present study, we found that the mean DFT was 11.6 ± 9.24J using modern era devices that performed the measurements with step-bystep DFT testing, and in almost half of the study patients (49.4%), the VF was terminated by a low energy (5J).…”

Section: Discussionmentioning

confidence: 99%

Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

et al. 2017

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SummaryDefibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantations is considered necessary for appropriate shock therapy and to measure the safety margin. However, the relationship between the DFT with modern era devices and the clinical outcome, including the total mortality is limited, which may lead to DFT testing itself being questioned. This study aimed to evaluate the relationship between the DFT and clinical outcome in ICD recipients.We enrolled 81 consecutive patients (66 males, aged 64.6 ± 13.8 years) who received an ICD implantation and underwent DFT testing. The DFT was measured with a step-by-step method in the patients upon implant. Further, we evaluated the relationship between the DFT and the clinical outcome, which included major cardiac adverse events and any cause of death.The mean DFT was 11.6 ± 9.24J in total. In 40 patients (49.4%), VF was terminated by a low output (5J), whereas 11 patients (13.6%) had a high DFT. The rates of atrial fibrillation were significantly higher in the high DFT group (63.6% versus 24.2%, P = 0.007). During the observational period (median 432 days; range from 151 days to 1146 days), the incidence of clinical events occurred in 22 patients (27.2%) in total. In a multivariate analysis, a high DFT was the only predictive factor for the incidence of the clinical outcome (OR 4.54, 95% CI 1.03-21.9, P = 0.045).(Int Heart J 2017; 58: 874-879) Key words: Defibrillation threshold testing, Major adverse cardiac events, High DFT I mplantable cardioverter defibrillators (ICDs) have been shown to reduce the total mortality when used for the primary and secondary prevention of sudden cardiac death (SCD). 1,2) Therefore, ICD implantations play a key role in patients who have a risk of SCD. Defibrillation threshold (DFT) testing is performed after the ICD implantation to assure adequate sensing and defibrillation of ventricular fibrillation (VF). However, previous reports showed that the DFT testing during ICD implantations is neither effective nor beneficial. 3-9) The SIMPLE trial 10) is a single-blind, randomized, multicenter, non-inferiority trial comparing the efficacy and safety of ICD implantations with DFT or without DFT testing. Recently it demonstrated that a routine DFT test at the time of the ICD implantation does not improve shock efficacy or reduce arrhythmic death. However, Ziegelhoeffer, et al. reported that intraoperative DFT testing might still be recommended because the previous prospective clinical trials were limited to de novo implants of high-energy generators and neglected a large number of patients already implanted with an ICD system. 11) Furthermore, the determination of the actual DFT enables lower energy shocks and thus potentially reduces the energy required for defibrillation, shortens the charging time, reduces the risk of loss of consciousness, and decreases the myocardial damage.In the present study, we enrolled various types of ICD recipients (an initial ICD or cardiac resynchronization therapy devices...

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“…9) The cause of increased risk may be postulated that the negative inotropic consequences of the shock itself could increase the risk of death, especially when the patient receives multiple shocks due to oversensing or in response to ongoing supraventricular tachycardia. [10][11][12][13] Thus, effective strategies to reduce ICD shocks are desirable. Antiarrhythmic medication is frequently administered in patients with an ICD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Additional Amiodarone Therapy in Patients with an Implantable Cardioverter‐Defibrillator

Matsumoto

Kumagai

Ogawa

et al. 2010

Journal of Arrhythmia

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Introduction: We examined whether the additional use of amiodarone (AMD) under implantable cardioverter-defibrillator (ICD) therapy may have beneficial effects in patients at risk for lethal ventricular arrhythmias with structural heart diseases.Methods: Sixty patients (47 males, mean age, 62 AE 13 years) with structural heart disease who underwent ICD implantation were retrospectively analyzed. There were 2 groups: one group (AMD group) was treated with AMD (n ¼ 33) and the other group (non-AMD group) was treated without AMD (n ¼ 27). We compared the incidence and appropriateness of ICD shock therapy between two groups.Results: During a mean follow-up of 28 AE 17 months, we identified a total of 62 episodes in 18 patients (30%) who received ICD shock therapy. ICD shock episodes were significantly less frequent in AMD group than in non-AMD group (15% versus 48%, P < 0:01), while inappropriate shock episodes were greater in non-AMD group than in AMD group (49% versus 4%, P ¼ 0:03). In cumulative probability of shock events, the risk of events was significantly lower in AMD group (P ¼ 0:007). Of 4 patients who died in AMD group, we observed one fatal pulmonary fibrosis.Conclusions: Additional AMD therapy in patients with an ICD may be effective in reducing the risk of shock discharge. (J Arrhythmia 2010; 26: 103-110)

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High-Energy Defibrillation Increases the Severity of Postresuscitation Myocardial Dysfunction

Abstract: The severity of postresuscitation myocardial dysfunction is related, at least in part, to the magnitude of the electrical energy of the delivered shock.

Cited by 255 publications

References 34 publications

Application of Entropy-Based Features to Predict Defibrillation Outcome in Cardiac Arrest

Application of Entropy-Based Features to Predict Defibrillation Outcome in Cardiac Arrest

Impact of the Relationship between the Defibrillation Threshold (DFT) and Clinical Outcomes in Recipients of Modern Era Implantable Cardioverter Defibrillator (ICD)

Efficacy of Additional Amiodarone Therapy in Patients with an Implantable Cardioverter‐Defibrillator

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