The Electrophysiological Effects of Defibrillation Shocks

  • Stephen M. Dillon
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 188)


THIS VOLUME describes the remarkable progress made in the technical development and the clinical application of the implantable cardioverter-defibrillator. Such progress is more remarkable for having been made in the absence of a complete understanding of how electrical shocks terminate arrhythmias. However, nearly a century after the start of scientific investigations into the mechanisms of defibrillation, we may only now be at the threshold of attaining such an understanding. This chapter will discuss what has been thought and what we have learned about the electro-physiological effects of shocks and how these effects relate to the overall defibrillation process.


Electrophysiological Effect Shock Strength Optical Recording Myocardial Membrane Defibrillation Shock 
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  1. 1.
    Prevost JL, Battelli F. Sur quelques effets de decharges electriques sur le coeur des mammiferes. Comptes Rendus Acad Sci 1899;129:1267–1268.Google Scholar
  2. 2.
    Gurvich NL, Yuniev GS. Restoration of regular rhythm in the mammalian fibrillating heart. Am Rev Sov Med 1946;3:236–239.PubMedGoogle Scholar
  3. 3.
    Hooker DR, Kouwenhoven WB, Langworthy OR. The effects of alternating electrical currents on the heart. Am J Physiol 1933;103:444–454.Google Scholar
  4. 4.
    Chen PS, Shibata N, Dixon EG, et al. Activation during ventricular defibrillation in open-chest dogs. Evidence of complete cessation and regeneration of ventricular fibrillation after unsuccessful shocks. J Clin Invest 1986;77:810–823.PubMedCrossRefGoogle Scholar
  5. 5.
    Witkowski FX, Penkoske PA, Plonsey R. Mechanism of cardiac defibrillation in open-chest dogs with unipolar DC-coupled simultaneous activation and shock potential recordings. Circulation 1990;82:244–260.PubMedCrossRefGoogle Scholar
  6. 6.
    Mower MM, Mirowski M, Spear JF, et al. Patterns of ventricular activity during catheter defibrillation. Circulation 1974;69:858–861.CrossRefGoogle Scholar
  7. 7.
    Zipes DP, Fischer J, King RM, et al. Termination of ventricular fibrillation in dogs by depolarizing a critical amount of myocardium. Am J Cardiol 1975;36:37–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Geddes LA, Niebauer MJ, Babbs CF, et al. Fundamental criteria underlying the efficacy and safety of defibrillating waveforms. Med & Biol Eng & Comput 1985;23:122–130.CrossRefGoogle Scholar
  9. 9.
    Dillon S, Wit AL. Transmembrane voltage changes recorded during counter-shock in normal rhythm. Circulation 1987;76:IV-242.(abstract)Google Scholar
  10. 10.
    Dillon SM, Wit AL. Use of voltage sensitive dyes to investigate electrical defibrillation. Proc IEEE Eng in Med and Biol 1988;10:215–216.CrossRefGoogle Scholar
  11. 11.
    Dillon SM: The electrophysiological effects of defibrillation shocks, In: Josephson ME, Wellens HJJ (eds) Tachycardias: Mechanisms and Management. Mount Kisco, NY, Futura Press, 1993 pp 457–477.Google Scholar
  12. 12.
    Chen PS, Wolf PD, Ideker RE. Mechanism of cardiac defibrillation. A different point of view. Circulation 1991;84:913–919.PubMedCrossRefGoogle Scholar
  13. 13.
    Witkowski FX, Kerber RE. Currently known mechanisms underlying direct current external and internal cardiac defibrillation. J Cardiovasc Electrophysiol 1991;2:562–572.CrossRefGoogle Scholar
  14. 14.
    Ideker RE, Wolf PD, Tang ASL: Mechanisms of defibrillation, In: Tacker WA (ed) Defibrillation of the heart. ICDs, AEDs, and Manual. St. Louis, Mosby, 1994 pp 15–45.Google Scholar
  15. 15.
    Spach MS, Barr RC, Serwer GA, et al. Extracellular potentials related to intercellular action potentials in the dog purkinje system. Circ Res 1972;30:505–519.PubMedCrossRefGoogle Scholar
  16. 16.
    Biermann M, Shenasa M, Borgreffe M, et al. The interpretation of cardiac electrograms, In: Shenasa M, Borgreffe M, Breithardt G, et al (eds) Cardiac Mapping. Mount Kisco, NY, Futura, 1993 pp 11–34.Google Scholar
  17. 17.
    rearce JA, Bourland JD, Neilsen W, et al. Myocardial stimulation with ultrashort duration current pulses. PACE 1982;5:52–58.CrossRefGoogle Scholar
  18. 18.
    Jones JL, Lepeschkin E, Jones RE, et al. Response of cultured myocardial cells to countershock-type electrical field stimulation. Am J Physiol 1978;235:H214-H222.Google Scholar
  19. 19.
    Moore EN, Spear JF: Electrophysiologic studies on the initiation, prevention, and termination of ventricular fibrillation, In: Zipes DP, Jalife J (eds) Cardiac Electrophysiology and Arrhythmias. Orlando, Grune & Stratton Inc., 1985, pp 315–322.Google Scholar
  20. 20.
    Witkowski FX, Penkoske PA. A new fabrication technique for directly coupled transmural cardiac electrodes. Am J Physiol 1988;254:H804-H810.Google Scholar
  21. 21.
    Zhou X, Knisley SB, Wolf PD, et al. Prolongation of repolarization time by electric field stimulation with monophasic and biphasic shocks in open-chest dogs. Circ Res 1991;68:1761–1767.PubMedCrossRefGoogle Scholar
  22. 22.
    Dillon SM: Use of optical recording for investigating electrical defibrillation, In: Clinical Application of Modern Image Technologies II. Proceedings SPIE Progress in Biomedical Optics. Bellingham, WA, SPIE, 1994, pp 387–396.Google Scholar
  23. 23.
    Dillon SM. Optical recordings in the rabbit heart show that defibrillation strength shocks prolong the duration of depolarization and the refractory period. Circ Res 1991;69:842–856.PubMedCrossRefGoogle Scholar
  24. 24.
    Knisley SB, Blitchington TF, Hill BC, et al. Optical measurements of transmembrane potential changes during electrical field stimulation of ventricular cells. Circ Res 1993;72:255–270.PubMedCrossRefGoogle Scholar
  25. 25.
    Dillon S, Morad M. A new laser scanning system for measuring action potential propagation in the heart. Science 1981;214:453–456.PubMedCrossRefGoogle Scholar
  26. 26.
    Hill BC, Courtney KR. Design of a multi-point laser scanned optical monitor of cardiac action potential propagation. Ann Biomed Eng 1987;15:567–577.PubMedCrossRefGoogle Scholar
  27. 27.
    Fujii S, Hirota A, Kamino K. Optical recording of the development of electrical activity in embryonic chick heart during early phases of cardiogenesis. J Physiol (Lond) 1981;311:147–160.Google Scholar
  28. 28.
    Davidenko JM, Pertsov AV, Salomonz R, et al. Stationary and drifting spiral waves of excitation in isolated cardiac muscle. Nature 1992;355:349–351.PubMedCrossRefGoogle Scholar
  29. 29.
    Hirano K, Sawanobori T, Hiraoka M. Circus movement tachycardia examined by the optical recording and by the computer simulation. Jap Heart J 1982;23:109–111.Google Scholar
  30. 30.
    Dillon SM: Optical mapping, In: Shenasa M, Borgreffe M, Breithardt G, Haverkamp W, Hindricks G (eds) Cardiac Mapping. Mount Kisco, NY, Futura, 1993, pp 587–606.Google Scholar
  31. 31.
    Waggoner AS, Grinvald A. Mechanisms of rapid changes of potential sensitive dyes. Ann NY Acad Sci 1977;303:217–241.PubMedGoogle Scholar
  32. 32.
    Cohen LB, Salzberg BM. Optical measurement of membrane potential. Rev Physiol Biochem Pharmacol 1978;83:35–88.PubMedGoogle Scholar
  33. 33.
    Waggoner AS. Dye indicators of membrane potential. Ann Rev Biophys Bioeng 1979;8:47–68.CrossRefGoogle Scholar
  34. 34.
    George EB, Nyirjesy P, Basson M, et al. Impermeant potential-sensitive oxonol dyes. I. Evidence for an “On-Off” mechanism. J Memb Biol 1988;103:245–253.CrossRefGoogle Scholar
  35. 35.
    Fluhler E, Burnham VG, Loew LM. Spectra, membrane binding, and potentiometric responses of new charge shift probes. Biochem 1985;24:5749–5755.CrossRefGoogle Scholar
  36. 36.
    Dillon SM, Wit AL. Voltage sensitive dye recordings from intact hearts using optical fibers. Biophys J 1988;53:641a. (abstract)Google Scholar
  37. 37.
    Moe GK. Computer simulation of atrial fibrillation. Comp Biomed Res 1965;2:217–238.Google Scholar
  38. 38.
    Allessie MA, Lammers WJEP, Bonke FIM, et al. Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation, In: Zipes DP, Jalife J (eds) Cardiac Electrophysiology and Arrhythmias. Orlando, Grune & Stratton Inc., 1985, pp 265–275.Google Scholar
  39. 39.
    Janse MJ, van Cappelle FJ, Morsink H, et al. Flow of “injury” current and patterns of excitation during early ventricular arrhythmias in acute regional myocardial ischemia in isolated porcine and canine hearts: evidence for two different arrhythmogenic mechanisms. Circ Res 1980;47:151–165.PubMedCrossRefGoogle Scholar
  40. 40.
    Pogwizd SM, Corr PB. Electrophysiologic mechanisms underlying arrhythmias due to reperfusion of ischemic myocardium. Circulation 1987;76:404–426.PubMedCrossRefGoogle Scholar
  41. 41.
    Harumi K, Smith CR, Abildskov JA, et al. Detailed activation sequence in the region of electrically induced ventricular fibrillation in dogs. Jap Heart J 1980;21:533–544.PubMedCrossRefGoogle Scholar
  42. 42.
    Bayly PV, Johnson EE, Wolf PD, et al. A quantitative measurement of spatial order in ventricular fibrillation. J Cardiovasc Electrophysiol 1993;4:533–546.PubMedCrossRefGoogle Scholar
  43. 43.
    Ideker RE, Wolf PD, Simpson E, et al. The ideal cardiac mapping system, In: Shenasa M, Borgreffe M, Breithardt G, Haverkamp W, Hindricks G (eds) Cardiac Mapping. Mount Kisco, NY, Futura, 1993, pp 649–653.Google Scholar
  44. 44.
    Winfree A: Theory of spirals, In: Zipes DP, Jalife J (eds) Cardiac Electro-physiology. From Cell to Bedside. 2nd ed. Philadelphia, W.B. Saunders, 1994, pp 379–389.Google Scholar
  45. 45.
    Zhou X, Guse P, Wolf PD, et al. Existence of both fast and slow channel activity during the early stages of ventricular fibrillation. Circ Res 1992;70:773–786.PubMedCrossRefGoogle Scholar
  46. 46.
    Wharton JM, Wolf PD, Smith WM, et al. Cardiac potential and potential gradient fields generated by single, combined, and sequential shocks during ventricular defibrillation. Circulation 1992;85:1510–1523.PubMedCrossRefGoogle Scholar
  47. 47.
    Dillon SM, Mehra R. Prolongation of ventricular refractoriness by defibrillation shocks may be due to additional depolarization of the action potential. J Cardiovasc Electrophysiol 1992;3:442–456.CrossRefGoogle Scholar
  48. 48.
    Dillon SM. Constant repolarization time after a defibrillation shock. FASEB J 1990;4:A682.(abstract)Google Scholar
  49. 49.
    Dillon SM. Synchronized repolarization after defibrillation shocks. A possible component or the defibrillation process demonstrated by optical recordings in rabbit heart. Circulation 1992;85:1865–1878.PubMedCrossRefGoogle Scholar
  50. 50.
    Kao CY, Hoffman BF. Graded and decrementai response in heart muscle fibers. Am J Physiol 1958;194:187–196.PubMedGoogle Scholar
  51. 51.
    Frazier DW, Krassowska W, Chen PS, et al. Extracellular field required for excitation in three-dimensional anisotropic canine myocardium. Circ Res 1988;63:147–164.PubMedCrossRefGoogle Scholar
  52. 52.
    Wiggers CJ, Wegria R. Ventricular fibrillation due to single, localized induction and condenser snocks applied during the vulnerable phase of ventricular systole. Am J Physiol 1940;128:500–505.Google Scholar
  53. 53.
    Chen PS, Shibata N, Dixon EG, et al. Comparison of the defibrillation threshold and the upper limit of ventricular vulnerability. Circulation 1986;73:1022–1028.PubMedCrossRefGoogle Scholar
  54. 54.
    Shibata N, Chen PS, Dixon EG, et al. Influence of shock strength and timing on induction of ventricular arrhythmias in dogs. Am J Physiol 1988;255:H891-H901.Google Scholar
  55. 55.
    Zipes DP. Electrophysiological mechanisms involved in ventricular fibrillation. Circulation 1975;52:120–130.Google Scholar
  56. 56.
    Sweeney RJ, Gill RM, Steinberg MI, et al. Ventricular refractory period extension caused by defibrillation shocks. Circulation 1990;82:965–972.PubMedCrossRefGoogle Scholar
  57. 57.
    Li HG, Jones DL, Yee R, et al. Defibrillation shocks increase myocardial pacing threshold: An intracellular microelectrode study. Am J Pnysiol 1991;260:H1973-H1979.Google Scholar
  58. 58.
    Yabe S, Smith WM, Daubert JP, et al. Conduction disturbances caused by high current density electric fields. Circ Res 1990;66:1190–1203.PubMedCrossRefGoogle Scholar
  59. 59.
    Jones JL, Jones RE. Postshock arrhythmias — a possible cause of unsuccessful defibrillation. Crit Care Med 1980;8:167–171.PubMedCrossRefGoogle Scholar
  60. 60.
    Jones JL, Jones RE. Improved defibrillator waveform safety factor with biphasic waveforms. Am J Physiol 1983;245:H60-H65.Google Scholar
  61. 61.
    Plonsey R, Barr RC. Effect of microscopic and macroscopic discontinuities on the response of cardiac tissue to defibrillating (stimulating) currents. Med & Biol Eng & Comput 1986;24:130–136.CrossRefGoogle Scholar
  62. 62.
    Dillon SM. Action potential prolongation by defibrillation shocks may be due to reactivation of the rapid sodium current. Biophys J 1994;66:A82. (abstract)Google Scholar
  63. 63.
    Goto M, Brooks CM. Membrane excitability of the frog ventricle examined by long pulses. Am J Physiol 1969;217:1236–1245.PubMedGoogle Scholar
  64. 64.
    Krassowska W, Pilkington TC, Ideker RE. Periodic conductivity as a mechanism for cardiac stimulation and defibrillation. IEEE Trans Biomed Eng 1987;34:555–560.PubMedCrossRefGoogle Scholar
  65. 65.
    Swartz JF, Jones JL, Jones RE, et al. Conditioning prepulse of biphasic defibrillator waveforms enhances refractoriness to fibrillation wavefronts. Circ Res 1991;68:438–449.PubMedCrossRefGoogle Scholar
  66. 66.
    Chen PS, Wolf PD, Claydon FJ, et al. The potential gradient field created by epicardial defibrillation electrodes in dogs. Circulation 1986;74:626–636.PubMedCrossRefGoogle Scholar
  67. 67.
    Swartz JF, Jones JL, Fletcher RD. Symmetrical biphasic defibrillator waveforms enhance refractory period stimulation in the human heart. J Am Coll Cardiol 1991;17:335. (abstract)CrossRefGoogle Scholar
  68. 68.
    Jones JL: Waveforms for implantable cardioverter defibrillators (ICDs) and transchest defibrillation, In: lacker WA (ed) Defibrillation of the Heart. ICDs, AEDs, and Manual. St. Louis, Mosby, 1994, pp 46–81.Google Scholar
  69. 69.
    Witkowski FX, Penkoske PA. Refractoriness prolongation by defibrillation shocks. Circulation 1990;82:1064–1066.PubMedCrossRefGoogle Scholar
  70. 70.
    Wang T, Kwaku KF, Dillon SM. Repolarization resynchronization may underlie the efficacy of biphasic shocks. Circulation 1994;90:1–446.(abstract)CrossRefGoogle Scholar
  71. 71.
    Fabritz CL, Kirchoff PF, Fletcher RD, et al. Post-shock repolarization time dispersion measured by two monophasic action potential recordings predicts defibrillation success in humans. Circulation 1994;90:1–446.(abstract)CrossRefGoogle Scholar

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© Springer Science+Business Media New York 1996

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  • Stephen M. Dillon

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