Changes in cerebral oxygen uptake and cerebral electrical activity during defibrillation threshold testing

Anesthesia and Analgesia
J W de VriesA C van Huffelen

Abstract

During cardioverter-defibrillator implantation, repeated episodes of ventricular fibrillation (VF) are induced. Insufficient recovery of oxygen metabolism may cause neurological sequelae. In this prospective clinical study, we monitored the electroencephalogram (EEG), middle cerebral artery blood flow velocity (Vmca), and jugular bulb oxygen saturation and estimated cerebral oxygen uptake. Results were analyzed for tests requiring a single shock (Group 1) and tests requiring multiple shocks for defibrillation (Group 2). Immediately after the induction of VF, the mean arterial blood pressure (MAP) decreased to < 30 mm Hg, and the Vmca decreased to 0 cm/s. The EEG showed ischemic changes consisting of a decrease of fast, and an increase of slow, activity, progressively declining to isoelectricity within 11 +/- 2 s. After defibrillation, the MAP recovered rapidly regardless of the arrest duration (3 +/- 2 s). The EEG recovered within 17 +/- 9 and 22 +/- 12 s, respectively, for Groups 1 and 2 (P < 0.05) and did not reveal ischemic changes until induction of a subsequent arrest. In Group 1, the cerebral oxygen uptake increased to 191% +/- 31% of baseline values and returned to baseline in 16 +/- 7 s, whereas in Group 2, it increased...Continue Reading

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Citations

Oct 12, 2013·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·John H ShinJohn F Beshai
Mar 20, 2004·Neurophysiologie clinique = Clinical neurophysiology·Geneviève FlorenceBernard Gueguen
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Dec 13, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Karlheinz SeidlMark W Kroll
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Jun 12, 2016·Journal of Critical Care·R PanaJ Teitelbaum
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Nov 21, 2015·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Bruce L WilkoffUNKNOWN Document Reviewers
Jun 16, 2005·Pacing and Clinical Electrophysiology : PACE·Elizabeth McNeillShubhayan Sanatani
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