The Effect of Inducing Ventricular Fibrillation with 50‐Hz Pacing Versus T are Stimulation on the Ability to Defibrillate

Abstract

When testing an ICD, there are at least two techniques for inducing ventricular fibrillation: (1) high frequency (approximately equal to 50 Hz) pacing; and (2) a single T wave stimulus. It is generally assumed that these two methods yield similar results. This study directly tested this assumption. In six dogs, one defibrillation electrode was placed in the right ventricular (RV) apex and the second was placed cutaneously on the left thorax. All defibrillation and T wave stimuli were biphasic between these two electrodes. Pacing was monophasic from the tip of the RV catheter to the cutaneous patch. The voltage which defibrillates 50% of the time (DF50) was measured using a 10-step Bayesian up-down method. Observations for two DF50 measurements were randomly interleaved. For one DF50 measurement, fibrillation was induced with 99 pacing stimuli at a 20-ms pacing interval (50-Hz pacing). For the second DF50 measurement, fibrillation was induced with a single defibrillation shock of approximately 1/2 J delivered at a time corresponding to the peak of the T wave in the lead II electrogram (T wave stimuli). The average DF50 when measured after fibrillation induced with 50-Hz pacing was 379 +/- 54.6 V, as compared to 382 +/- 50.3 V when fibrillation was induced with T wave stimuli. The difference of 3 V was not statistically significant. If these results are confirmed in humans, it is reasonable to assume that the efficacy of a defibrillation shock is the same whether T wave stimuli or 50-Hz pacing are used to induce fibrillation.