Abstract
BackgroundSingle path defibrillation shock methods have been improved through the use of the Charge Banking Model of defibrillation, which predicts the response of the heart to shocks as a simple resistor-capacitor (RC) circuit. While dual path defibrillation configurations have significantly reduced defibrillation thresholds, improvements to dual path defibrillation techniques have been limited to experimental observations without a practical model to aid in improving dual path defibrillation techniques.MethodsThe Charge Banking Model has been extended into a new Extended Charge Banking Model of defibrillation that represents small sections of the heart as separate RC circuits, uses a weighting factor based on published defibrillation shock field gradient measures, and implements a critical mass criteria to predict the relative efficacy of single and dual path defibrillation shocks.ResultsThe new model reproduced the results from several published experimental protocols that demonstrated the relative efficacy of dual path defibrillation shocks. The model predicts that time between phases or pulses of dual path defibrillation shock configurations should be minimized to maximize shock efficacy.DiscussionThrough this approach the Extended Charge Banking Model predictions may be used to improve dual path and multi-pulse defibrillation techniques, which have been shown experimentally to lower defibrillation thresholds substantially. The new model may be a useful tool to help in further improving dual path and multiple pulse defibrillation techniques by predicting optimal pulse durations and shock timing parameters.
Highlights
Charge Banking and Charge Burping Models of Defibrillation More than a century ago, Weiss and Lapique carried early electrophysical experiments to characterize the response of excitable muscle tissue to electrical stimuli[1,2]
We propose an Extended Charge Banking Model for multi-pulse defibrillation which will allow investigators to compare leading edge voltage and energy requirements of dual path shocks as compared to a control waveform
The results from experimental work as described by KenKnight et al with the auxiliary pulse and the Extended Charge Banking Model are shown in Figure 6C and 6D
Summary
Charge Banking and Charge Burping Models of Defibrillation More than a century ago, Weiss and Lapique carried early electrophysical experiments to characterize the response of excitable muscle tissue to electrical stimuli[1,2]. Kroll developed an approach to model the response of cardiac tissue to the capacitive discharge of a defibrillation shock [4]. Charge Banking states that charge is built up over the cell membrane and that since the stimulation pulses are capacitive discharges, there is an optimal duration where the membrane voltage of the cardiac cells reaches a maximum. He developed equations describing optimal pulse duration and system capacitance that maximize the response of the model to shocks. While dual path defibrillation configurations have significantly reduced defibrillation thresholds, improvements to dual path defibrillation techniques have been limited to experimental observations without a practical model to aid in improving dual path defibrillation techniques
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