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Ann Thorac Surg 1996;61:275
© 1996 The Society of Thoracic Surgeons

Correspondence

Potassium Conversion of Ventricular Fibrillation

Francis Robicsek, MD

The Sanger Clinic, PA, 1001 Blythe Blvd, Suite 300, Charlotte, NC 28203

To the Editor:

I read with great interest the article ``Conversion of Postischemic Ventricular Fibrillation With Intraaortic Infusion of Potassium Chloride'' by Ovrum and associates in the July 1995 issue of The Annals [1]. The article presents quite convincingly (as a novel method) the advantages of nonelectric (biochemical) defibrillation after open heart operations.

I would like to insert the historical correction that a technique very similar, if not identical, was published by me in the January 1984 issue of The Journal of Thoracic and Cardiovascular Surgery under the title ``Biochemical Termination of Sustained Fibrillation Occurring After Artificially Induced Ischemic Arrest'' [2].

References

  1. Øvrum E, Tangen G, Åm Holen E, Ringdal MAL, Istad R. Conversion of postischemic ventricular fibrillation with intraaortic infusion of potassium chloride. Ann Thorac Surg 1995;60:156–9.[Abstract/Free Full Text]
  2. Robicsek F. Biochemical termination of sustained fibrillation occurring after artificially induced ischemic arrest. J Thorac Cardiovasc Surg 1984;87:143–5.[Abstract]
 

Reply

Eivind Øvrum, MD, Geir Tangen, MD

Oslo Heart Center, Pilestredet 32, 0027 Oslo, Norway

To the Editor:

We appreciate very much the interest expressed by Dr Robicsek, regarding our article on a simplified method of managing postischemic ventricular fibrillation [1]. The article reports on the effects of potassium chloride administered through the arterial line from the heart-lung machine. This is an alternative to electrical countershocks, and the technique is performed by the perfusionist by adding potassium into the oxygenator reservoir. The procedure does not manually involve the surgeons, who may proceed uninterrupted with the operation. In our study, including 200 patients, the method was successful in 82% of the cases, and in the remaining patients, the number of countershocks required for defibrillation was significantly smaller compared with a control group treated primarily with electrical shocks.

We are fully aware of the article published in 1984 [2] by Dr Robicsek, dealing with the serious clinical syndrome of sustained ventricular fibrillation that does not respond to electrical shocks. This method includes biomechanical termination of the persistant ventricular fibrillation with repeat cross-clamping of the ascending aorta, infusion of warm potassium cardioplegic solution into the coronary system, and, after cardiac arrest has been achieved, pacing of the heart by the ventricular mode. This is certainly a different technique applied to a quite different clinical situation than reported in our article. However, when discussing the issue of intraoperative ventricular fibrillation, the work of Dr Robicsek is relevant. Therefore, we enjoy this opportunity to focus on his particular technique, which obviously is most effective in the troublesome situation of persistant ventricular fibrillation.

Addendum

The correct concentration of procain chloride in our cardioplegic solution is 1.0 mmol/L and not 0.1 mmol/L as erroneously stated in the article.

References

  1. Øvrum E, Tangen G, Åm Holen E, Ringdal MAL, Istad R. Conversion of postischemic ventricular fibrillation with intraaortic infusion of potassium chloride. Ann Thorac Surg 1995;60:156–9.
  2. Robicsek F. Biochemical termination of sustained fibrillation occurring after artificially induced ischemic arrest. J Thorac Cardiovasc Surg 1984;87:143–5.



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Home page
 Ann. Thorac. Surg.Home page
F. Robicsek, E. Ovrum, and G. Tangen
Potassium Conversion of Ventricular Fibrillation
Ann. Thorac. Surg., August 1, 1996; 62(2): 624 - 624.
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