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Evaluation of a new de fibrillation pathway tongue epigastric tongue apex route 2. impedance characteristics in human subjects

, : Evaluation of a new de fibrillation pathway tongue epigastric tongue apex route 2. impedance characteristics in human subjects. Journal of the American College of Cardiology 4(2): 253-258

An automated device for defibrillation using a vertical shock pathway (tongue-epigastric or tongue-apex) was developed. The energy requirements for defibrillation using vertical pathways are uncertain and will be determined largely by the impedance of the pathway. To determine the impedance characteristics of vertical defibrillation pathways in humans subjects, 20 patients undergoing elective cardioversion of atrial fibrillation or atrial flutter, or both, were studied. Patients received shocks from electrodes placed in tongue-epigastric or tongue-cardiac apex positions. The tongue electrode was a 12 cm2 metal plate fixed to a standard plastic oropharyngeal airway. The epigastric or cardiac apex electrode was a 40 cm2 selfadhesive pad. The electrodes were connected to a standard damped-sinusoidal waveform defibrillator. The 2 vertical shock pathways evidently had substantially higher impedance than the standard transthoracic pathway: tongue-epigastric pathway 130 .+-. 11.OMEGA. (SD), tongue-apex pathway 115 .+-. 12.OMEGA. transthoracic pathway 68 .+-. 11.OMEGA. (P < 0.05). The higher impedance is probably due to the longer interelectrode distances of vertical pathways: tongue-epigastric 33 .+-. 3 cm, tongue-apex 28 .+-. 3 cm, transthoracic 23 .+-. 3 cm (P < 0.05). Vertical pathway shocks were successful in the cardioversion of 15 of 20 patients. Four of the five patients in whom vertical shocks were unsuccessful subsequently underwent successful cardioversion by transthoracic shocks; the transthoracic shocks achieved a higher current because of lower impedance of the transthoracic route. Vertical shock pathways in human subjects apparently have higher impedance than do transthoracic pathways. Because of this higher impedance, higher energy may be required for vertical pathway defibrillation than for standard transthoracic defibrillation.

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