Double defibrillation

The Björk-Shiley mechanical valve was the first tilting-disc valve used to replace aortic and mitral valves. We present a case of a double aortic and mitral valve replacement with both valves functioning properly over 48 years after the original implantation. Minimal negative changes are evident in either valve despite the progression of cardiac abnormalities, including the development of a dilated cardiomyopathy associated with chronic systolic and diastolic heart failure and the implantation of an implantable cardioverter defibrillator (ICD)...

A recent study in NEJM (DOSE-VF) showed that administering two consecutive defibrillation shocks with two separate defibrillators improves outcomes for patients with out-of-hospital cardiac arrest (OHCA). This approach was used when a shockable rhythm persisted after three standard shocks, raising the question of new strategies to improve survival for patients with persistent ventricular fibrillation (VF). In the Netherlands, there are around 8,000 OHCA cases annually, with 49% attributed to shockable rhythms...

OBJECTIVE: Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. We report the trends in survival after a ventricular fibrillation/pulseless ventricular tachycardia OHCA, over a 13-year period, in a French urban region, and describe the simultaneous evolution of the rescue system. METHODS: We investigated four 18-month periods between 2005 and 2018...

BRCA2 and RAD51 are two proteins that play a central role in homologous recombination (HR) and DNA double strand break (DSB) repair. BRCA2 assists RAD51 fibrillation and defibrillation through binding with its eight BRC repeats, with BRC4 being one of the most efficient and best characterized. RAD51 inactivation by small molecules has been proposed as a strategy to impair BRCA2/RAD51 binding and, ultimately, the HR pathway, with the aim of making cancer cells more sensitive to PARP inhibitors (PARPi). This strategy, which mimics a synthetic lethality (SL) approach, has been successfully performed in vitro by using the myristoylated derivative of BRC4 (myr-BRC4), designed for a more efficient cell entry...

BACKGROUND AND OBJECTIVE: Double sequential external defibrillation (DSED) and vector-change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular fibrillation (VF) refractory of standard defibrillation (SD). Therefore, this network meta-analysis aims to evaluate the comparative efficacy of DSED, VCD, and SD for refractory VF. METHODS: A systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) and comparative observational studies retrieved from PubMed, EMBASE, WOS, SCOPUS, and Cochrane through November 15th, 2022...

There is no single resuscitation strategy that will uniformly improve cardiac arrest outcomes. Traditional vital signs cannot be relied on in cardiac arrest, and the use of continuous capnography, regional cerebral tissue oxygenation, and continuous arterial monitoring are options for use early defibrillation are critical elements of resuscitation. Cardio-cerebral perfusion may be improved with the use of active compression-decompression CPR, an impedance threshold device, and head-up CPR. In refractory shockable arrest, if ECPR is not an option, consider changing defibrillator pad placement and/or double defibrillation, additional medication options, and possibly stellate ganglion block...

The etiological diagnosis of ischemic stroke is crucial for secondary prevention, but often complex for the patients' cardiovascular comorbidities, each of which may cause a stroke. We report the case of an 84-year-old patient with severe left ventricular systolic dysfunction due to dilated cardiomyopathy and implantable cardioverter-defibrillator in primary prevention, hospitalized for atherothrombotic ischemic stroke treated conservatively and later by carotid thromboendarterectomy for ulcerated plaque of the right internal carotid artery...

OBJECTIVE: To determine if human automated external defibrillators (AEDs) could successfully record cardiac electrical activity in dogs, make appropriate recommendations regarding shock delivery, and characterize skin preparation required for a readable ECG based on dog haircoat characteristics. DESIGN: Prospective study of AED use in dogs conducted between January and March 2021. SETTING: University teaching hospital. ANIMALS: Three groups of client-owned dogs were evaluated...

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BACKGROUND: Ventricular fibrillation (VF) is a common arrhythmia that occurs after the release of aortic cross-clamp (ACC) in patients undergoing cardiopulmonary bypass (CPB) surgery. Repeated defibrillation and long duration of VF could increase myocardial injuries. In patients with left ventricular hypertrophy (LVH), VF is easier to occur and more difficult to be terminated. Amiodarone, known as class III antiarrhythmic agent, has the prominent properties of converting VF and restoring the sinus rhythm...

INTRODUCTION: Double sequential external defibrillation (DSED) in cardiopulmonary resuscitation has shown different results in comparison with standard defibrillation in the treatment of refractory ventricular fibrillation (RVF). This review aims to compare the advantages of DSED with standard defibrillation in the treatment of refractory ventricular fibrillation. MATERIALS AND METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to May 1, 2022...

BACKGROUND: Despite advances in defibrillation technology, shock-refractory ventricular fibrillation remains common during out-of-hospital cardiac arrest. Double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators) and vector-change (VC) defibrillation (switching defibrillation pads to an anterior-posterior position) have been proposed as defibrillation strategies to improve outcomes in patients with refractory ventricular fibrillation. METHODS: We conducted a cluster-randomized trial with crossover among six Canadian paramedic services to evaluate DSED and VC defibrillation as compared with standard defibrillation in adult patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest...

Among multiple causes of tracheobronchial rent, most common is iatrogenic factor. Whenever there is surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and postoperative management pose a challenge. We report a 16-year-old girl, weighing 27kg, a case of pulmonary Koch's who presented with hydropneumothorax on left side. She had a prolonged course on mechanical ventilation, was gradually weaned off and extubated in intensive care unit (ICU) with implantable cardioverter defibrillator (ICD) in-situ...

Double sequential defibrillation is proposed as a novel modality of managing refractory ventricular fibrillation (VF). However, existing evidence has not been enough to support this. Here, we report an interesting case of a 54-year-old male who suffered from cardiac arrest with VF rhythm. The patient did not respond to 11 consecutive shocks along with antiarrhythmic medications. However, double sequential defibrillation terminated the VF. He had another episode of VF unresponsive to thirty minutes of standard defibrillation on his way to the catheterization laboratory...

Background: The atrial sites suitable for lead placement are limited after complex surgical atrial procedures, and lead placement can be challenging in patients with congenitally corrected transposition of the great arteries (ccTGA) after intracardiac repair. Case summary: A 34-year-old man with ccTGA, who had undergone a double-switch operation with combined Senning and Jatene operations at the age of 14 was transferred to us. He experienced faintness and suffered cardiopulmonary arrest, and electrocardiography revealed ventricular fibrillation...

BACKGROUND: Double Sequential External Defibrillation (DSED) is a proposed treatment strategy for patients in refractory VF (RVF) during out-of-hospital cardiac arrest (OHCA). Defibrillator damage employing DSED is a theoretical concern expressed by defibrillator manufacturers yet the incidence of damage during resuscitation remains unknown. OBJECTIVE: We sought to explore the incidence of defibrillator damage employing DSED for RVF during OHCA. METHODS: We conducted a survey of EMS agencies, authors of previous publications, EMS medical directors, base hospital medical oversight groups, and defibrillator manufacturers to assess the incidence of defibrillator damage during DSED...

Sports are a double-edged sword. On the one hand, cardiovascular benefits from sports activity are well-known, and on the other hand, sports may increase the risk of sudden cardiac death (SCD) in subjects with known or unknown cardiovascular diseases. SCD is rare but has a very strong emotional issue. There are many examples involving famous professional athletes, but this is only scratching the surface of a widespread phenomenon that also involves amateur athletes. The importance of safely performing physical activity appears clear in both professional and amateur athletes...

BACKGROUND: Defibrillation guidelines recommend avoiding patient contact during shock delivery. However, hands-on defibrillation (compressions during shock) and manual pressure augmentation (MPA - pushing on the defibrillator pads during shock) may lead to improved clinical outcomes. There are limited data addressing the protection provided by personal protective equipment (PPE) during hands-on defibrillation and MPA. This study investigated the hand-to-hand and hand-to-knee leakage current experienced by a simulated kneeling provider wearing different PPE...

AIMS: Myotonic dystrophy type 1 (DM1) predisposes to the development of life-threatening arrhythmias and sudden cardiac death. Our study aimed to evaluate the prognostic value of programmed ventricular stimulation (PVS) in DM1 patients with conduction system disease. METHODS AND RESULTS: Arrhythmic CArdiac DEath in MYotonic dystrophy type 1 patients (ACADEMY 1) is a double-arm non-randomized interventional prospective study. Myotonic dystrophy type 1 patients with permanent cardiac pacing indication were eligible for the inclusion...

We describe the case of a young female patient with hypertrophic cardiomyopathy (HCM) with a dual chamber implantable cardioverter defibrillator (ICD), and complete heart block from a prior septal ablation procedure. Due to persistent left ventricular outflow tract (LVOT) obstruction and symptoms, she underwent surgical myectomy. Her exertional symptoms continued despite improved LVOT flow parameters. A comprehensive evaluation, including ICD interrogation, helped arrive at the correct diagnosis and treatment plan...