Myocardial effects of repeated electrical defibrillations in the isolated fibrillating rat heart

Gazmuri, Raúl J.; Deshmukh, Smriti; Shah, Pragnesh R.

doi:10.1097/00003246-200008000-00002

Cited by 34 publications

(14 citation statements)

References 31 publications

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“…In addition to the duration of untreated CA and the duration of the resuscitation efforts, other important factors that contribute to myocardial injury include the underlying myocardial state prior to CA and the delivery of electrical shocks when indicated, which has been associated with worse myocardial function [50,51]. Moreover, the use of vasopressor agents during CPR has also been linked to intensified ischemia and worse postresuscitation myocardial dysfunction [52].…”

Section: Differences In Postresuscitation Myocardial Dysfunctionmentioning

confidence: 99%

The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management

Varvarousis

Varvarousi

Iacovidou

et al. 2015

The American Journal of Emergency Medicine

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Section: Differences In Postresuscitation Myocardial Dysfunctionmentioning

confidence: 99%

The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management

Varvarousis

Varvarousi

Iacovidou

et al. 2015

The American Journal of Emergency Medicine

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“…Defibrillation after prolonged untreated VF typically requires multiple electrical shocks, which in and of themselves can cause myocardial injury (24,25). In addition, interruptions in chest compression, which are required to deliver electrical shocks, also can be detrimental (18).…”

Section: Energy For Successful Defibrillationmentioning

confidence: 99%

Optimal timing for electrical defibrillation after prolonged untreated ventricular fibrillation

Kolarova

Ayoub

et al. 2003

Critical Care Medicine

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“…In contrast, measures of adverse cardiac function were not observed when coronary perfusion was maintained. 13,14 Thus, the cellular environment of the ischemic and hypoperfused, fibrillating ventricle was the dominant cause of altered hemodynamic function.…”

Section: Rhythm Shock or Substrate?mentioning

confidence: 99%

Shocks

Poole

2011

Circ: Arrhythmia and Electrophysiology

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I n this edition of Circulation: Arrhythmia and Electrophysiology, Elayi and colleagues 1 examined mortality in patients from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study who received external (transthoracic) cardioversion shocks for atrial fibrillation (AF) compared with those who had not received cardioversion shocks. The AFFIRM trial studied 4060 patients with a history of AF and compared a strategy of rhythm control versus rate control. 2 The strategy of using antiarrhythmic drug therapy to maintain sinus rhythm did not improve all-cause mortality when compared with rate control. In this substudy analysis of AFFIRM, the association of cardioversion shocks and subsequent risk of death was determined using Cox proportional hazards modeling. The primary finding was that patients who received cardioversion shocks were not at higher risk of death compared with the patients who did not receive cardioversion shocks. Other than an association of cardioversion with cardiac hospitalizations, these neutral findings were independent of ejection fraction, numbers of cardioversion episodes, or history of permanent versus paroxysmal AF. Article see p 465It is important to emphasize that a Cox proportional hazards model examines association of variables and does not establish "cause and effect." 3 The finding in the study by Elayi et al that there was an association of having had a cardioversion episode and having been hospitalized for cardiac reasons illustrates this principal. For instance, the hospitalization could have been for the purpose of medical management of the patient's AF, during which AF was treated with cardioversion, or for exacerbation of a chronic cardiac condition that triggered AF and then required cardioversion. The data do not elucidate the specific reasons for the observed association.The findings from this substudy of AFFIRM are relevant to the much broader debate about the association of implantable cardioverter-defibrillator (ICD) shocks with subsequent mortality. Post hoc analyses of data from the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) have raised concerns about the safety of shock therapy. 4 -7 In both of these large, prospective, randomized trials, the mortality risk as assessed by the Cox proportional hazards method was higher in patients who had ICD shock therapies than in those who did not. Over the study follow-up time period, the mortality risk for patients having shocks for ventricular fibrillation (VF) or ventricular tachycardia (VT) was 3-to 6-fold that of ICD patients not shocked for VT or VF. In addition, there was a 2-fold increased mortality risk associated with inappropriate ICD shocks. The majority of inappropriate shocks were due to either AF or another supraventricular arrhythmia detected in the high-rate ICD therapy zones.The association of ICD shocks with an increase in subsequent mortality has led to a resurrection of animal research from the 198...

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Myocardial effects of repeated electrical defibrillations in the isolated fibrillating rat heart

Abstract: These findings indicate that repetitive low-energy electrical shocks do not accentuate postischemic systolic dysfunction in the isolated fibrillating rat heart but adversely affect postischemic diastolic dysfunction by reducing the unstressed left ventricular end-diastolic volume.

Cited by 34 publications

References 31 publications

The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management

The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management

Optimal timing for electrical defibrillation after prolonged untreated ventricular fibrillation

Shocks

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