defibrillation

defibrillation, the administration of electric shocks to the heart in order to reset normal heart rhythm in persons who are experiencing cardiac arrest or whose heart function is endangered because of severe arrhythmia (abnormality of heart rhythm).

Types of defibrillation devices

There are several different kinds of defibrillation devices. The two major types are automated external defibrillators (AEDs) and automatic implantable cardioverter defibrillators (ICDs). AEDs are used in emergency situations involving cardiac arrest. They are portable and often can be found in places where large numbers of people circulate, such as airports. Immediate emergency response that enables early defibrillation is central to the successful restoration of heart rhythm during cardiac arrest. Emergency personnel are trained in the use of AEDs; however, AEDs are designed to be used by members of the general public as well, regardless of training. Many countries that supply AEDs in public areas offer training courses, often in conjunction with training in CPR (cardiopulmonary resuscitation).

ICDs are used in patients at high risk of sustained or recurrent arrhythmia that has the potential to impair heart function. An ICD consists of a shock generator and wires with electrodes on both ends. The generator is implanted under the skin in the chest or abdomen and is connected to the wires, which are fed through a major vein to reach the atria or ventricles of the heart. When a disturbance in rhythm is detected by the ICD, it delivers an electric shock to the heart to reestablish normal rhythm; this is known as cardioversion. When the heart rhythm becomes chaotic, the ICD delivers a shock that resets the rhythm. Cardioversion and defibrillation have enabled ICDs to prevent sudden death in some patients affected by severe ventricular arrhythmias. ICDs can be programmed to perform other functions, including slowing heart rhythm in persons with tachycardia (abnormally fast heart rate) and increasing heart rhythm in persons with bradycardia (abnormally slow heart rate).

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History of defibrillation

Defibrillation has long been recognized as a lifesaving procedure. One of the first reported incidents in which electricity was used for the resuscitation of an apparently dead individual occurred in England in 1774 when electric shocks applied to the thorax of a young girl reestablished her pulse. In the 1780s British surgeon Charles Kite invented a precursor of the modern defibrillation device. Later studies, including those conducted by Italian physician and physicist Luigi Galvani in the 1790s and by Italian physicist Carlo Matteucci in the 1840s, shed light on the electrical properties of animal tissues. In fact, Matteucci, in his studies of electricity detection in pigeons, was the first to detect an electrical current in the heart. Research performed in the following decades led to an improved understanding of the electrical features of heart rhythm.

In 1947 American physician Claude S. Beck, who had been investigating new techniques for defibrillation in humans, reported having successfully reestablished normal heart rhythm in a patient with ventricular fibrillation (irregular and uncoordinated contraction of the ventricle muscle fibres) during heart surgery. Beck’s defibrillation technique and device served as a prototype for the development of modern defibrillators. In the 1960s Polish-born American physician Michel Mirowski came up with an idea for the development of an automatic implantable cardioverter defibrillator, which could be used in patients affected by certain types of arrhythmia. The first ICD was implanted in a patient on Feb. 4, 1980.

Emergency personnel began being trained in defibrillation in the 1960s, and the first automated external defibrillator devices were clinically tested in the early 1980s. The first AEDs delivered strong shocks in a monophasic waveform and often required multiple shocks to reestablish heart rhythm. Later AEDs were refined to deliver shocks in a biphasic waveform, which, relative to monophasic shock, was found to be safer and more effective.