Intraoperative comparison of sequential-pulse and single-pulse defibrillation in candidates for automatic implantable defibrillators.

Sixteen survivors of cardiac arrest underwent intraoperative comparison of the effectiveness of sequential-pulse and single-pulse defibrillation. Defibrillation was tested alternately with the single-pulse or sequential-pulse technique 10 seconds into an episode of ventricular fibrillation that was induced with alternating current. The sequential-pulse defibrillation technique using truncated exponential pulses was performed with a right ventricular endocardial catheter and a left ventricular epicardial patch electrode. The first pulse was delivered between the right ventricular apical and the superior vena caval electrode on the right ventricular endocardial catheter. The second pulse was delivered between the right ventricular apical electrode and the left ventricular patch electrode 0.2 ms after termination of the first pulse. Single-pulse defibrillation was performed with a standard intracardiac defibrillation system in which a single truncated exponential pulse was delivered across 2 epicardial patch electrodes positioned over the anterolateral right ventricle and the posterolateral left ventricle. During defibrillation threshold determination, voltage and current waveforms were recorded and integrated to determine delivered energy. Average defibrillation threshold leading-edge voltage for the sequential pulse technique was 496 +/- 140 V, compared with 365 +/- 157 V for the single-pulse technique (p less than 0.005). Defibrillation threshold leading-edge current for the sequential-pulse technique was 6.0 +/- 2.3 A, compared with 10.6 +/- 5.1 A for the single-pulse method (p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)