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The Upper Limit of Vulnerability and Critical Points for Defibrillation

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Cardiac Bioelectric Therapy

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Abstract

Electrical shocks delivered during the repolarization phase of the cardiac cycle can initiate ventricular fibrillation. However, shocks delivered above a certain threshold, called the upper limit of vulnerability, will no longer induce arrhythmias. The upper limit of vulnerability is tied closely to the defibrillation threshold, which is the minimum energy which can be delivered to terminate ventricular fibrillation. Induction of and termination of fibrillation is determined by the creation of critical points, the intersection of a critical level of refractoriness with a critical level of extracellular potential gradient. Virtual electrode critical points may also be created by large changes in transmembrane potential over a short distance, which can form new activation wavefronts and reinitiate arrhythmias.

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Acknowledgments

This work was supported in part by National Health Institutes, Heart, Lung and Blood Institute Research Grants HL 128752 and grant support from the Treadwell Foundation.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery and The Nora Eccles Harrison Cardiovascular Research Training Institute, University of Utah, Salt Lake City, UT, USA

    Derek J. Dosdall

  2. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA

    Raymond E. Ideker

Authors
  1. Derek J. Dosdall
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  2. Raymond E. Ideker
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Correspondence to Derek J. Dosdall .

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Editors and Affiliations

  1. Department of Biomedical Engineering, The George Washington University, Washington, DC, USA

    Igor R. Efimov

  2. National Heart & Lung Institute, Imperial College London, London, UK

    Fu Siong Ng

  3. Philips EPD Solutions, Cambridge, MA, USA

    Jacob I. Laughner

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Dosdall, D.J., Ideker, R.E. (2021). The Upper Limit of Vulnerability and Critical Points for Defibrillation. In: Efimov, I.R., Ng, F.S., Laughner, J.I. (eds) Cardiac Bioelectric Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-63355-4_9

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