### Abstract

Vulnerability to VF in Humans. Introduction: Shocks during the vulnerable period of the cardiac cycle induce ventricular fibrillation (VF) if their strength is above the VF threshold (VFT) and less than the upper limit of vulnerability (ULV). However, the range of shock strengths that constitutes the vulnerable zone and the corresponding range of coupling intervals have not been defined in humans. The ULV has been proposed as a measure of defibrillation because it correlates with the defibrillation threshold (DFT), but the optimal coupling interval for identifying it is unknown. Methods and Results: We studied 14 patients at implants of transvenous cardioverter defibrillators. The DFT was defined as the weakest shock that defibrillated after 10 seconds of VF. The ULV was defined as the weakest shock that did not induce VF when given at 0, 20, and 40 msec before the peak of the T wave or 20 msec after the peak in ventricular paced rhythm at a cycle length of 500 msec. The VFT was defined as the weakest shock that induced VF at any of the same four intervals. To identify the upper and lower boundaries of the vulnerable zone, we determined the shock strengths required to induce VF at all four intervals for weak shocks near the VFT and strong shocks near the ULV. The VFT was 72 ± 42 V, and the ULV was 411 ± 88 V. In all patients, a shock strength of 200 V exceeded the VFT and was less than the ULV. The coupling interval at the ULV was 19 ± 11 msec shorter than the coupling interval at the VFT (P <0.001). The vulnerable zone showed a sharp peak at the ULV and a less distinct nadir at the VFT. A 20-msec error in the interval at which the ULV was measured could have resulted in underestimating it by a maximum of 95 ± 31 V. The weakest shock that did not induce VF was greater for the shortest interval tested than for the longest interval at both the upper boundary (356 ± 108 V vs 280 ± 78 V; P <0.01) and lower boundary (136 ± 68 msec vs 100 ± 65 msec; P <0.05). Conclusions: The human vulnerable zone is not symmetric with respect to a single coupling interval, but slants from the upper left to lower right. Small differences in the coupling interval at which the ULV is determined or use of the coupling interval at the VFT to determine the ULV may result in significant variations in its measured value. An efficient strategy for inducing VF would begin by delivering a 200-V shock at a coupling interval 10 msec before the peak of the T wave.

Original language | English (US) |
---|---|

Pages (from-to) | 145-154 |

Number of pages | 10 |

Journal | Journal of Cardiovascular Electrophysiology |

Volume | 8 |

Issue number | 2 |

State | Published - 1997 |

Externally published | Yes |

### Fingerprint

### Keywords

- defibrillation
- sudden death
- ventricular fibrillation

### ASJC Scopus subject areas

- Cardiology and Cardiovascular Medicine
- Physiology

### Cite this

*Journal of Cardiovascular Electrophysiology*,

*8*(2), 145-154.

**The zone of vulnerability to T wave shocks in humans.** / Swerdlow, Charles D.; Martin, David J.; Kass, Robert M.; Davie, Scott; Mandel, William J.; Gang, Eli S.; Chen, Peng-Sheng.

Research output: Contribution to journal › Article

*Journal of Cardiovascular Electrophysiology*, vol. 8, no. 2, pp. 145-154.

}

TY - JOUR

T1 - The zone of vulnerability to T wave shocks in humans

AU - Swerdlow, Charles D.

AU - Martin, David J.

AU - Kass, Robert M.

AU - Davie, Scott

AU - Mandel, William J.

AU - Gang, Eli S.

AU - Chen, Peng-Sheng

PY - 1997

Y1 - 1997

N2 - Vulnerability to VF in Humans. Introduction: Shocks during the vulnerable period of the cardiac cycle induce ventricular fibrillation (VF) if their strength is above the VF threshold (VFT) and less than the upper limit of vulnerability (ULV). However, the range of shock strengths that constitutes the vulnerable zone and the corresponding range of coupling intervals have not been defined in humans. The ULV has been proposed as a measure of defibrillation because it correlates with the defibrillation threshold (DFT), but the optimal coupling interval for identifying it is unknown. Methods and Results: We studied 14 patients at implants of transvenous cardioverter defibrillators. The DFT was defined as the weakest shock that defibrillated after 10 seconds of VF. The ULV was defined as the weakest shock that did not induce VF when given at 0, 20, and 40 msec before the peak of the T wave or 20 msec after the peak in ventricular paced rhythm at a cycle length of 500 msec. The VFT was defined as the weakest shock that induced VF at any of the same four intervals. To identify the upper and lower boundaries of the vulnerable zone, we determined the shock strengths required to induce VF at all four intervals for weak shocks near the VFT and strong shocks near the ULV. The VFT was 72 ± 42 V, and the ULV was 411 ± 88 V. In all patients, a shock strength of 200 V exceeded the VFT and was less than the ULV. The coupling interval at the ULV was 19 ± 11 msec shorter than the coupling interval at the VFT (P <0.001). The vulnerable zone showed a sharp peak at the ULV and a less distinct nadir at the VFT. A 20-msec error in the interval at which the ULV was measured could have resulted in underestimating it by a maximum of 95 ± 31 V. The weakest shock that did not induce VF was greater for the shortest interval tested than for the longest interval at both the upper boundary (356 ± 108 V vs 280 ± 78 V; P <0.01) and lower boundary (136 ± 68 msec vs 100 ± 65 msec; P <0.05). Conclusions: The human vulnerable zone is not symmetric with respect to a single coupling interval, but slants from the upper left to lower right. Small differences in the coupling interval at which the ULV is determined or use of the coupling interval at the VFT to determine the ULV may result in significant variations in its measured value. An efficient strategy for inducing VF would begin by delivering a 200-V shock at a coupling interval 10 msec before the peak of the T wave.

AB - Vulnerability to VF in Humans. Introduction: Shocks during the vulnerable period of the cardiac cycle induce ventricular fibrillation (VF) if their strength is above the VF threshold (VFT) and less than the upper limit of vulnerability (ULV). However, the range of shock strengths that constitutes the vulnerable zone and the corresponding range of coupling intervals have not been defined in humans. The ULV has been proposed as a measure of defibrillation because it correlates with the defibrillation threshold (DFT), but the optimal coupling interval for identifying it is unknown. Methods and Results: We studied 14 patients at implants of transvenous cardioverter defibrillators. The DFT was defined as the weakest shock that defibrillated after 10 seconds of VF. The ULV was defined as the weakest shock that did not induce VF when given at 0, 20, and 40 msec before the peak of the T wave or 20 msec after the peak in ventricular paced rhythm at a cycle length of 500 msec. The VFT was defined as the weakest shock that induced VF at any of the same four intervals. To identify the upper and lower boundaries of the vulnerable zone, we determined the shock strengths required to induce VF at all four intervals for weak shocks near the VFT and strong shocks near the ULV. The VFT was 72 ± 42 V, and the ULV was 411 ± 88 V. In all patients, a shock strength of 200 V exceeded the VFT and was less than the ULV. The coupling interval at the ULV was 19 ± 11 msec shorter than the coupling interval at the VFT (P <0.001). The vulnerable zone showed a sharp peak at the ULV and a less distinct nadir at the VFT. A 20-msec error in the interval at which the ULV was measured could have resulted in underestimating it by a maximum of 95 ± 31 V. The weakest shock that did not induce VF was greater for the shortest interval tested than for the longest interval at both the upper boundary (356 ± 108 V vs 280 ± 78 V; P <0.01) and lower boundary (136 ± 68 msec vs 100 ± 65 msec; P <0.05). Conclusions: The human vulnerable zone is not symmetric with respect to a single coupling interval, but slants from the upper left to lower right. Small differences in the coupling interval at which the ULV is determined or use of the coupling interval at the VFT to determine the ULV may result in significant variations in its measured value. An efficient strategy for inducing VF would begin by delivering a 200-V shock at a coupling interval 10 msec before the peak of the T wave.

KW - defibrillation

KW - sudden death

KW - ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=0031034415&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031034415&partnerID=8YFLogxK

M3 - Article

VL - 8

SP - 145

EP - 154

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 2

ER -