DEFIBRILLATORS
59. Defibrillators
Defibrillators are devices used to restore normal cardiac rhythm by delivering a burst of electrical energy to the
heart. This ‘burst’ depolarises all the myocytes essentially re-setting the electrical status of the heart and allowing
co-ordinated myocardial depolarisation to occur again. There are various types that can be manual or automated,
monophasic or biphasic, external, transvenous or implanted in the patient.
What is the difference between
monophasic and biphasic
waveform defibrillators?
Draw the major components in
a defibrillator circuit.
How does a defibrillator work?
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> Monophasic waveform: This is a damped sinusoidal wave (Lown-type
waveform). Current flows in one direction only, from one electrode
to the other.
> Biphasic waveform: This can be either a biphasic truncated exponential
waveform or a rectilinear biphasic waveform. Current flows in alternating
directions, completing one cycle in approximately 10 ms. During the first
phase, current flows in one direction and then reverses direction during
the second phase. This lowers the electrical threshold for successful
defibrillation, allowing lower energy levels to be used and reducing the
risk of burns and myocardial damage. Biphasic defibrillation was originally
developed and used for implantable cardioverter defibrillators.
5000 V d.c.
Switch
Charge
Discharge
Capacitor
Inductor
Patient’s Heart Paddle switch
Fig. 59.1  Components of a defibrillator circuit
> Delivers DC shock (AC causes myocardial damage and is
arrhythmogenic).
> Uses 5000 V (this is much greater than that of the mains electricity and
is produced using a step-up transformer).
> A capacitor is used to store charge. It consists of two conducting plates
separated by an insulating material (dielectric). Capacitance is measured
in farads (F). The amount of charge it can store depends on the size of
the plates, their separating gap and the dielectric material. They have
a low reactance to AC (i.e. passes AC) but a high resistance to DC
(i.e. blocks DC).
Charge (Q) = Capacitance (C) × Voltage (V)
Energy stored (E) = ½ CV2
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 02 PHYSICS
How do cardioversion and
defibrillation differ?
How can you calculate the energy
that will be delivered during
a shock?
What are the safety considerations Use of a defibrillator necessarily means discharging a large amount of
when using a defibrillator?
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> An inductor is used to prolong the duration of current discharge (see
Chapter 58, ‘Electrical components’). It consists of coils of conducting
material wound around a ferrous core (former). A magnetic flux is induced
whenever a current flows through the coils causing back EMF and
prolonging the charge. They have a high reactance to AC (i.e. block AC)
but a low resistance to DC (i.e. pass DC).
> It produces a DC shock from 30 A, for 3 ms with 5000 V.
> The delivered (quoted) energy is less than stored charge due to some
loss within the inductor.
> Thoracic impedance is in the region of 50–150 Ω. This is reduced
after the first shock, by the use of conductive gel pads, front-to-back
defibrillation and application of firm paddle pressure.
> External biphasic defibrillators deliver an energy of 150 J while monophasic
ones deliver 360 J. Internal cardiac defibrillators (ICD) use 20–50 J.
> During cardioversion, a synchronised DC shock must be administered in
order to prevent ‘R on T’ phenomenon, which can trigger VF.
> During defibrillation of pulseless VT or VF, a non-synchronised shock can
be administered.
> The energy delivered during cardioversion is often lower than for
defibrillation e.g. 50 J for atrial fibrillation using a biphasic defibrillator,
compared to 200 J for VF.
This can be done using the equation E = ½ CV2
> If C is 100 μF and V is 2000 V, then E = ½ (0.0001)(20002) = 200 J
> Energy stored will be 200 J.
In reality the energy delivered will be slightly less due to some loss within the
system.
energy. If this is not done safely it can lead to:
> Burns.
> Ignition of flammable material and gases (fire and explosions).
> Interference with electrical components in contact with the patient such
as ICDs and pacemakers.
> Precipitation of VF if shock intended to cardiovert is not synchronised
correctly with patient’s cardiac rhythm.
> Electrocution of staff and patient.
These risks can be minimised by:
> Allowing only trained personnel to deliver shocks.
> Ensuring all personnel are ‘standing clear’ when the shocks are delivered,
i.e. not touching the patient and trolley/bed.
> Maintaining and checking defibrillator regularly.
> Having an audible alarm that signifies when defibrillator machine
is ‘charging’ and ‘ready to shock’.
> Having dry surroundings (patient and staff must not be in contact with
fluid that can conduct the charge).
> Placing defibrillator pads on dry skin correctly to ensure maximal contact.
If the pads are only partially in contact with the patient there will be a
higher current density through the part that is in contact and this can lead
to burns.
> Taking oxygen away/disconnecting it from the patient prior to delivery
of shock.
> Having regular training and simulation sessions.
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