To the Editor.—
When discussing transthoracic ventricular defibrillation, Loeb (232:845, 1975; 235:144, 1976) and Tacker et al (235:144, 1976) overlooked both direct-current (DC) countershock using low-level electrical energy and miniature defibrillators. More than 35 years ago, Wiggers1 showed that serial low-energy shocks expedite ventricular defibrillation. Recent experiments, corroborating and extending these earlier observations, indicate that only a limited critical mass of ventricle need be defibrillated for restoration of intrinsic cardiac pacemaker function.2 In humans, prospective investigation of transthoracic defibrillation showed that the stored 200 watt-second (W-sec) DC shock provided an average 3.1 (1.8-4.0) W-sec/kg. This 200 W-sec shock eliminated primary ventricular fibrillation on the first shock in 73 and on the second shock in 7 of 80 cardiac patients. Two others needed higher energy levels for defibrillation.3 Our early experience confirms this report (Table). Thus, 86 episodes of prospectively assessed human ventricular fibrillation responded to an average
Crampton RS, Hunter FP. Low-Energy Ventricular Defibrillation and Miniature Defibrillators. JAMA. 1976;235(21):2284. doi:10.1001/jama.1976.03260470012006
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