Defibrillator

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Electrical device used since 1947 to restore the ventricular rhythm from ventricular fibrillation or ventricular tachycardia to normal if all goes well. It is widely and successful used in community and hospital practice. Similar (often identical!) devices are used for DC cardioversion of other arrhythmias. Implantable defibrillators are a successful, if relatively expensive, intervention in selected patients.[1]

Contents

Defibrillation

In the case of within hospital cardiac arrest we have fair evidence in the form of survival until hospital discharge of how important the delay until the patient is defibrillated is[2].

Defibrillation is commonly external, needing a considerable and hazardous voltage and energy to affect the myocardium through the chest wall. Internal defibrillation with around a tenth of the energy using suitable paddles is not uncommon in cardiac surgery. Implantable defibrillators brought internal defibrillation out of the operating theatre and into the twentieth century.

History

  • 1947 - First use of internal defibrillation on human heart [3]
  • 1956 - External defibrillation described[4]
  • 1960 - External defibrillation used in a case of myocardial infarction[5]. Closed chest massage in man was described the same year[6].
  • 1961 - Closed chest massage and external defibrillation described together[7]
  • 1963 - Synchronised DC shock described (occurred 1962)[8]. CPR Cart described.[9]
  • 1976 - Principles of automatic implantable defibrillator described[10] with transvenous electrode[11]
  • 1980 - First automatic implantable defibrillator in man (reported later)[12][13]

See also

References

  1. Exner DV, Sheldon RS, Pinski SL, Kron J, Hallstrom A. Do baseline characteristics accurately discriminate between patients likely versus unlikely to benefit from implantable defibrillator therapy? Evaluation of the Canadian implantable defibrillator study implantable cardioverter defibrillatory efficacy score in the antiarrhythmics versus implantable defibrillators trial. American heart journal. 2001 Jan; 141(1):99-104.
  2. Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. The New England journal of medicine. 2008 Jan 3; 358(1):9-17.(Link to article – subscription may be required.)
  3. http://www.cwru.edu/artsci/dittrick/site2/museum/artifacts/group-c/c-8defrib.htm
  4. ZOLL PM, LINENTHAL AJ, GIBSON W, PAUL MH, NORMAN LR. Termination of ventricular fibrillation in man by externally applied electric countershock. The New England journal of medicine. 1956 Apr 19; 254(16):727-32.
  5. NAST PR, PENNYPACKER CS, WAGNER JA. Successful external electrical defibrillation in acute myocardial infarction. Report of a case. Circulation. 1960 Jul; 22:138-43.
  6. KOUWENHOVEN WB, JUDE JR, KNICKERBOCKER GG. Closed-chest cardiac massage. JAMA : the journal of the American Medical Association. 1960 Jul 9; 173:1064-7.
  7. LAKRA P, SHIPMAN KH. Closed-chest cardiac massage. Followed by use of external defibrillation. Rocky Mountain medical journal. 1961 Jul; 58:33-4.
  8. KITCHEN LD. ELECTRONIC SYNCHRONISER FOR DIRECT-CURRENT DEFIBRILLATION. Lancet. 1963 Dec 21; 2(7321):1310-1.
  9. ISRAEL JS, MCCULLA K, DOBKIN AB. A CART FOR CARDIOPULMONARY RESUSCITATION. Canadian Medical Association journal. 1963 Dec 21; 89:1284-9.
  10. Langer A, Heilman MS, Mower MM, Mirowski M. Considerations in the development of the automatic implantable defibrillator. Medical instrumentation. 1976 May-Jun; 10(3):163-7.
  11. Ewy GA, Horan W. Electode catheter for transvenous defibrillation. Medical instrumentation. 1976 May-Jun; 10(3):155-8.
  12. Watkins L, Mirowski M, Mower MM, Reid PR, Griffith LS, Vlay SC, Weisfeldt ML, Gott VL. Automatic defibrillation in man. The initial surgical experience. The Journal of thoracic and cardiovascular surgery. 1981 Oct; 82(4):492-500.
  13. Watkins L, Mower MM, Reid PR, Platia EV, Griffith LS, Mirowski M. Trials of the automatic implantable defibrillator in man. A three-year program report. The Journal of thoracic and cardiovascular surgery. 1983 Sep; 86(3):381-7.