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Defibrillation – Restoring Heart Rhythm in Emergencies

Defibrillation is a medical procedure in which a controlled electric shock is delivered to the heart to restore a normal heart rhythm during a life-threatening cardiac emergency.

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Things worth knowing about "Defibrillation"

Defibrillation is a medical procedure in which a controlled electric shock is delivered to the heart to restore a normal heart rhythm during a life-threatening cardiac emergency.

What is Defibrillation?

Defibrillation is an emergency medical procedure in which a brief, controlled electrical shock is delivered through the chest wall to the heart. The goal is to interrupt dangerous heart rhythm disturbances – most notably ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) – and restore the normal heart rhythm (sinus rhythm). It is one of the most important life-saving interventions in emergency medicine.

When is Defibrillation Used?

Defibrillation is required when the heart stops pumping effectively because its electrical activity has become completely disorganized. The main indications are:

Ventricular Fibrillation (VF): Chaotic, uncoordinated electrical activity in the ventricles with no effective pumping function.
Pulseless Ventricular Tachycardia (pVT): Very rapid heartbeats originating in the ventricles without sufficient cardiac output.

Both conditions are fatal within minutes without immediate treatment. Defibrillation is the only effective therapy for these rhythms.

Mechanism of Action

The electrical impulse delivered during defibrillation simultaneously depolarizes a critical mass of heart muscle cells. This abruptly terminates the chaotic electrical activity. Afterwards, the natural pacemaker of the heart – the sinoatrial (SA) node – has the opportunity to regain control and initiate a normal, coordinated heartbeat.

Types of Defibrillation

Manual Defibrillation

Performed exclusively by trained medical professionals (e.g., emergency physicians, intensive care specialists). The operator analyzes the heart rhythm and decides on the timing and energy of the shock (typically 150–360 joules, depending on the device type).

Automated External Defibrillation (AED)

An Automated External Defibrillator (AED) is a user-friendly device that can also be operated by laypersons. It automatically analyzes the heart rhythm and provides instructions to deliver a shock if necessary. AEDs are now widely available in public places such as train stations, airports, and sports venues.

Implantable Cardioverter-Defibrillator (ICD)

An ICD is a small device surgically implanted under the skin. It continuously monitors the heart rhythm and automatically delivers a shock when needed. It is used in patients at high risk of life-threatening arrhythmias.

Procedure and Steps

In an emergency, defibrillation is always performed in conjunction with cardiopulmonary resuscitation (CPR – chest compressions and rescue breathing). The typical steps are:

Ensure safety and call emergency services (911 or local emergency number).
Begin chest compressions immediately.
Turn on the AED and attach the electrode pads to the chest (one pad below the right collarbone, one below the left armpit).
Allow the AED to analyze the heart rhythm.
If a shock is advised: ensure nobody is touching the person, then press the shock button.
Resume chest compressions immediately after the shock.

Safety and Side Effects

Defibrillation is a safe procedure when applied correctly. Possible side effects and risks include:

Redness or minor skin burns at the electrode pad sites.
Muscle soreness from the muscular contraction caused by the shock.
In rare cases: temporary rhythm disturbances immediately following the procedure.

Important: No one should touch the patient while the shock is being delivered, to prevent injury to bystanders or rescuers.

References

European Resuscitation Council (ERC) – Guidelines for Resuscitation 2021. Resuscitation, 2021.
Zipes DP et al. – ACC/AHA/ESC 2006 Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Journal of the American College of Cardiology, 2006.
World Health Organization (WHO) – Cardiovascular Diseases: Key Facts. WHO, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

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