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Evaluation of a new de fibrillation pathway the tongue epigastric route 1. experimental studies in dogs


, : Evaluation of a new de fibrillation pathway the tongue epigastric route 1. experimental studies in dogs. Journal of the American College of Cardiology 2(5): 966-972

To determine the efficacy of a tongue-epigastric defrillation route in anesthetized dogs, ventricular fibrillation was induced by rectangular pulses passed down a transvenous catheter into the right ventricle. Three groups of dogs were studied. Group I (15 dogs) received shocks from a 12 cm2 tongue electrode, a 50 cm2 circular, gelled self-adhesive electrode pad placed on the epigastrium and standard transthoracic defibrillator paddle electrodes. Shocks were given at energy levels of 50 to 460 J (delivered energy, 50 .OMEGA. resistance). The success of the tongue-epigastric shocks in achieving defibrillation, and the resistance and current flow were determined at each energy level and compared with the same energy shocks from the standard transthoracic electrodes. In group II (5 dogs), comparisons were made between the 12 cm2 tongue electrode used in the 1st group of dogs and a larger tongue electrode of 40 cm2. In group III (5 dogs), intracardiac current flow (potental gradient) with tongue-epigastric and standard transthoracic electrodes was studied. In group I, defibrillation success with the tongue-epigastric electrodes ranged from no successs at 50-100 J to 83% success at 460 J. With standard transthoracic electrodes, success rates ranged from 65% at 50 J to 100% at 300 J. At all energies tested, the resistance was significantly higher and current significantly lower using tongue-epigastric compared with transthoracic electrodes. The higher tongue-epigastric resistance is probably related to the longer interelectrode distance; the correlation between interelectrode distance (x, in centimeters) and resistance (y, in .OMEGA.) in these dogs was y = 2.2x + 29.6, r = 0.78. In group II dogs, the larger tongue electrode caused only minimal improvement in current flow and success rates. In group III dogs, lower values for intracardiac current with tongue-epigastric electrode placement were found, reflecting the lower total current flow and increased interelectrode distance, with a lower proportion of net current traversing the heart. Evidently, tongue-epigastric defibrillation is feasible in dogs, but the pathway has higher resistance than the transthoracic route and thus more energy is required to defibrillate.

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