Evidence map›Paper›PMID 26767423›Full record

ArticleHeart rhythm2016

Tetanizing prepulse: A novel strategy to mitigate implantable cardioverter-defibrillator shock-related pain.

David W Hunter, Harikrishna Tandri, Henry Halperin, Leslie Tung, Ronald D Berger

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart rhythm, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. High-energy external defibrillation and transcutaneous pacing during MRI: feasibility and safety.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2019
    Article
  3. Review
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

David W HunterDepartment of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
Harikrishna TandriDepartment of Medicine, The Johns Hopkins University, Baltimore, Maryland.
Henry HalperinDepartment of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland; Department of Medicine, The Johns Hopkins University, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University, Baltimore, Maryland.
Leslie TungDepartment of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
Ronald D BergerDepartment of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland; Department of Medicine, The Johns Hopkins University, Baltimore, Maryland. Electronic address: rberger@jhmi.edu.
Johns Hopkins University · USJohns Hopkins Medicine · US

Funding

Improved Targeting and Assessment of Electrophysiology InterventionR01HL094610 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI HALPERIN, HENRY R · 2009 to 2018
$15.5M
Painless DefibrillationR44HL127771 · NHLBI · CORIDEA, LLC · PI LEVIN, HOWARD · 2015 to 2020
$4.0M
NHLBI NIH HHS R01 HL094610NHLBI NIH HHS R44 HL127771
6 · The paper itself

Abstract

backgroundSkeletal muscle activation has been implicated as the source of pain associated with implantable cardioverter-defibrillator shocks. We hypothesized that the skeletal muscle response to defibrillatory shocks could be attenuated with a tetanizing prepulse immediately before biphasic shock delivery.

objectiveThe purpose of this study was to test the ability of tetanizing prepulses to reduce the skeletal muscle activation associated with defibrillation.

methodsSeven adult pigs were studied. A left ventricular coil and subcutaneous dummy can in the right thorax were used to deliver either pure biphasic waveforms or test waveforms consisting of a tetanizing pulse of high-frequency alternating current (HFAC) ramped to an amplitude of 5-100 V over 0.25-1 second, immediately followed by a biphasic shock of approximately 9 J (ramped HFAC and biphasic [rHFAC+B]). We used limb acceleration and rate of force development as surrogate measures of pain. Test and control waveforms were delivered in sinus rhythm and induced ventricular fibrillation to test defibrillation efficacy.

resultsDefibrillation threshold energy was indistinguishable between rHFAC+B and pure biphasic shocks. Peak acceleration and rate of force development were reduced by 72% ± 7% and 71% ± 22%, respectively, with a 25-V, 1-second rHFAC+B waveform compared with pure biphasic shocks. Notably, rHFAC+B with a 9-J biphasic shock produced significantly less skeletal muscle activation than a 0.1-J pure biphasic shock.

conclusionA putative source of implantable cardioverter-defibrillator shock-related pain can be mitigated using a tetanizing prepulse followed by biphasic shock. Human studies will be required to assess true pain reduction with this approach.

Indexed as

Electric CountershockPainAnimalsDefibrillators, ImplantableDisease Models, AnimalElectric StimulationMuscle ContractionMuscle, SkeletalPain MeasurementSwineVentricular FibrillationDefibrillationImplantable cardioverter-defibrillatorPainSkeletal muscle

Identifiers

PMID26767423
PMCPMC4851876
OpenAlexW2264617778

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.