PMID: 8461513Mar 1, 1993Paper

Does ventricular fibrillation cause myocardial stunning during defibrillator implantation?

Journal of Cardiac Surgery
H M Spotnitz

Abstract

Induction of ventricular fibrillation (VF) is an important part of the process of inserting implantable cardioverter defibrillators (ICDs), allowing the measurement of defibrillation thresholds. However, animal studies have revealed that repeated cycles of VF and defibrillation result in depressed left ventricular (LV) function and reduced cardiac output. Short intervals of VF do not affect myocardial contractility but longer periods produce heart failure. Induced VF was used in a canine model to study profound myocardial stunning leading to heart failure, as well as the therapeutic potential of the phosphodiesterase inhibitor, amrinone (combined with epinephrine and norepinephrine). Amrinone was found to significantly (p < 0.05) increase contractility when added to a stable preparation supported by epinephrine and norepinephrine infusion; amrinone or catecholamines alone had no effect. In the clinical setting, the following factors may affect LV contractility during ICD surgery: catecholamines released as a result of hypotension; negative VF; ischemia; antiarrhythmic drugs; anesthetics; and bradycardia after device testing. Patients (n = 125) have tolerated ICD insertion well. Early data reveals no significant changes in eject...Continue Reading

References

May 1, 1991·Pacing and Clinical Electrophysiology : PACE·R A Winkle
Aug 1, 1985·Journal of the American College of Cardiology·M Mirowski
Aug 17, 2004·American Heart Journal·Jonathan E E Yager, G Michael Felker

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Citations

Jun 28, 2003·The Journal of Thoracic and Cardiovascular Surgery·David G RabkinHenry M Spotnitz
Jul 25, 2003·The Journal of Thoracic and Cardiovascular Surgery·Malcolm M DeCampEugene H Blackstone
Jun 20, 2002·Critical Care Medicine·Manuel Ruiz Bailén
Sep 16, 2003·Critical Care Medicine·Manuel Ruiz-BailénUNKNOWN ARIAM Group
Aug 24, 1999·Pacing and Clinical Electrophysiology : PACE·R BauernschmittS Hagl
Jul 13, 2012·Circulation. Arrhythmia and Electrophysiology·Daniel J FriedmanE Kevin Heist
Jun 1, 1994·Pacing and Clinical Electrophysiology : PACE·W M ParkH M Spotnitz
Jun 30, 2009·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Chi Keong ChingBruce L Wilkoff
Dec 13, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Karlheinz SeidlMark W Kroll
May 2, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Russell A DenmanHelen E Burnett
Nov 22, 2001·Cardiology Clinics·M O SweeneyW G Stevenson
Nov 1, 1994·The Annals of Thoracic Surgery·M M AmirhamzehH M Spotnitz
Feb 7, 2004·Pacing and Clinical Electrophysiology : PACE·Stephen R ShorofskyMichael R Gold
Apr 28, 2007·Pacing and Clinical Electrophysiology : PACE·Charles D SwerdlowPaul J Degroot
Apr 28, 2007·Pacing and Clinical Electrophysiology : PACE·David KeaneMark K Kroll

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