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Concept
Defibrillation
Summary
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart. Although not fully understood, this process depolarizes a large amount of the heart muscle, ending the arrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm. A heart which is in asystole (flatline) cannot be restarted by a defibrillator, but would be treated only by cardiopulmonary resuscitation (CPR) and medication. Like this asystole sometimes converts into a shockable rhythm, which can be treated by cardioversion or defibrillation.
In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle. Although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac arrhythmias, such as supraventricular tachycardia.
Defibrillators can be external, transvenous, or implanted (implantable cardioverter-defibrillator), depending on the type of device used or needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little or no training.
Defibrillation is often an important step in cardiopulmonary resuscitation (CPR). CPR is an algorithm-based intervention aimed to restore cardiac and pulmonary function. Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia. If the heart has completely stopped, as in asystole or pulseless electrical activity (PEA), defibrillation is not indicated. Defibrillation is also not indicated if the patient is conscious or has a pulse. Improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular fibrillation.
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