Introduction and history of defibrillation

The passage of electrical current through the myocardium to terminate ventricular fibrillation (VF) or ventricular tachycardia is the definitive treatment and single most important factor in surviving cardiac arrest due to VF. This chapter will review the history and theory of defibrillation, current techniques, and future developments of this critically important therapy.

In 1775, the Danish veterinarian–physician Abildgaard demonstrated that chickens could be stunned and revived by electrical shocks administered to the head and to the heart. Prevost and Batelli in 1899 showed that ventricular fibrillation in dogs could be terminated by electric shocks. In the twentieth century, the Consolidated Edison Company of New York became concerned about the high rate of accidental electrocutions among maintenance workers, and funded research on the cardiac consequences of electrical shocks. Supported by this source, Hooker et al. published important studies on defibrillation in animals. The first human defibrillation was performed in 1947 by Beck who administered shocks directly to the exposed epicardium in an operating room. The first closed-chest human defibrillation was achieved by Zoll et al. in 1956. Although alternating current was used originally, direct current quickly supplanted alternating current; postshock atrial arrhythmias were found to be reduced by use of direct current.

An important consequence of the early canine studies of defibrillation was the observation that arterial pressure rose when electrodes were pressed against the animal chest. This recognition of the role of chest compression in blood circulation and arterial pressure maintenance ultimately resulted in the development of closed-chest massage by Kouwenhoven et al.