BACKGROUND: Skeletal muscle activation has been implicated as the source of @entity158 associated with implantable @entity1457 . We hypothesized that the skeletal muscle response to defibrillatory shocks could be attenuated with a tetanizing prepulse immediately before @entity1457 delivery. OBJECTIVE: The purpose of this study was to test the ability of tetanizing prepulses to reduce the skeletal muscle activation associated with defibrillation. METHODS: Seven adult @entity1707 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 @entity1457 of approximately 9 J (ramped HFAC and biphasic [rHFAC+B]). We used limb acceleration and rate of force development as surrogate measures of @entity158 . Test and control waveforms were delivered in sinus rhythm and induced @entity2224 to test defibrillation efficacy. RESULTS: Defibrillation threshold energy was indistinguishable between rHFAC+B and pure @entity1457 . 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 @entity1457 . Notably, rHFAC+B with a 9-J @entity1457 produced significantly less skeletal muscle activation than a 0.1-J pure @entity1457 . CONCLUSION: A putative source of implantable cardioverter-defibrillator shock-related @entity158 can be mitigated using a tetanizing prepulse followed by @entity1457 . @entity1 studies will be required to assess true @entity158 reduction with this approach.

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

@entity1 :: ('9606', 'Species') :: ['Human'] @entity1707 :: ('9823', 'Species') :: ['pigs'] @entity1457 :: ('MESH:D012769', 'Disease') :: ['cardioverter-defibrillator shocks', 'biphasic shocks', 'biphasic shock'] @entity2224 :: ('MESH:D014693', 'Disease') :: ['ventricular fibrillation'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain']
@entity158 :: (MESH:D010146,Disease) :: ['pain']
