Emergency intracardiac defibrillation for refractory ventricular fibrillation

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 18; no. 2; pp. 109 - 111
• Main Authors: Haught, W. Herbert, Conti, Jamie B., Tucker, Kelly J., Curtis, Anne B.
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.02.1995; Wiley
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Electric Countershock - methods; Electrocardiography; Emergencies; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Humans; Intensive care medicine; intracardiac defibrillation; Male; Medical sciences; Middle Aged; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - therapy; ventricular tachycardia; Heart; Human; Intensive cardiocirculatory care; Arrhythmia; Instrumentation therapy; Cardiovascular disease; Excitability disorder; Ventricular fibrillation; Case study; Treatment; Heart disease; Emergency; Defibrillation; Negative therapeutic reaction
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960180214

Hemodynamically unstable ventricular arrhythmias induced during electrophysiologic testing almost always respond to prompt application of direct current transthoracic shocks. In rare cases, however, ventricular fibrillation may be refractory to conventional treatment. Recently, a technique of intracardiac defibrillation has been successfully used to resuscitate patients with ventricular fibrillation refractory to transthoracic defibrillation. We describe two patients with a history of myocardial infarction and left ventricular dysfunction who were admitted with symptomatic episodes of ventricular tachycardia. Both had inducible sustained monomorphic ventricular tachycardia. During a repeat electrophysiologic study in Patient No. 1 on procainamide and at the initial study in Patient No. 2, right ventricular burst pacing to terminate ventricular tachycardia resulted in ventricular fibrillation refractory to resuscitation efforts, including transthoracic defibrillation with 360 J. Emergency intracardiac defibrillation with 200 and 360 J, respectively, successfully converted both patients to sinus rhythm. Both patients were subsequently discharged from the hospital on amiodarone. These cases illustrate the life‐saving capabilities of intracardiac defibrillation.