Biomedical subjects

V Krasteva

Publications and source records attributed to V Krasteva.

7 recordsLinked to original sources

PubMedDate not supplied

Modelling transthoracic defibrillation waveforms.

Recent investigations connected with implantable defibrillators yielded new data on heart electrophysiology, resulting in reassessment of existing and advancing of new types of electrical impulses. Different electrical equivalent circuits were proposed for modelling intracardiac and transthoracic defibrillation pulse waveforms, comprising generator, electrode interface and tissue resistances. We attempted modelling of the transmembrane voltage Vm time course, induced by different applied voltage Vs waveforms, taking into account only the shapes and the relative Vs and Vm amplitudes. The excitable cell membrane impedance Zm was modelled with higher resistance and lower capacitance, so that a shunting effect on the generator and tissue resistances was avoided. The result was a very simple equivalent circuit. We proposed criteria for efficient defibrillation pulse waveforms yielding a straightforward approach to model existing and new pulses and to assess their efficiency.

Biomedical Engineering↗

PubMedDate not supplied

Automatic adjustment of biphasic pulse duration in transthoracic defibrillation.

Many studies have proven that biphasic defibrillation pulses are more efficient than the damped sinusoid monopolar waveform. Transthoracic resistance was shown to change during the two phases. On the other hand, it was proven that transthoracic resistance plays an important role in the defibrillation process, yielding the current for selected energy or voltage. Pre-shock measurement of the resistance may lead to improved selection. Stabilized current defibrillators are of low stored-to-delivered energy ratio. Therefore, automatic dynamic adjustment of some defibrillator parameters with respect to transthoracic resistance changes seems rational. An approach is known for modifying the pulse duration, in order to deliver a selected energy. A method is proposed here and an experimental defibrillator is developed for dynamic pulse duration adjustment with the purpose of obtaining a desired optimal time-course of the cardiac cell transmembrane potential.

Animals↗

PubMedDate not supplied

Assessment of balanced biphasic defibrillation waveforms in transthoracic atrial cardioversion.

Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid waveform, initiated in 60 s, was adopted in virtually all defibrillators. Biphasic pulses were introduced recently, achieving success with less energy. A biphasic exponential waveform was modelled with 4 ms duration per phase with a balanced 3:1 ratio of the first to second phase peak voltages and implemented in a defibrillator. A version obtained by chopping the pulses with a 5 kHz frequency was also used. It was hypothesized that the modelled transmembrane voltage decay time is a parameter that could be associated with successful defibrillation. The results of cardioversion for two groups of patients with the 'classic' monophasic waveform and with the biphasic pulses were compared. The mean efficient energy with the damped sinusoid was 205 +/- 85 J, versus 88 +/- 43 J with the biphasic pulses, yielding a ratio of 2.32 (1.92 to 3.2 for fibrillation and flutter, respectively). An acceptable agreement between model data and clinical results was found. The transmembrane voltage decay time ratios for monophasic versus biphasic pulses was in the approximate range of 2.5 to 3.5.

Atrial Fibrillation↗

PubMedDate not supplied

Transthoracic defibrillation with chopping-modulated biphasic waveforms.

The superiority of different biphasic pulses for transthoracic defibrillation was proven by several studies. These efficient waveforms were implemented in some commercially available defibrillators. Recently we have devised and evaluated a biphasic waveform with a specially balanced ratio of the first-to-second phase voltages and with 5 kHz frequency 1:1 on-off chopping. It used less than half the energy for successful defibrillation in comparison with the 'classic' monophasic damped sinusoidal wave and showed considerably less post-shock negative effects. This experience led us to try several laws of chopping modulation. A pulse-width modulation, combining low energy with gradual upslope of the modelled transmembrane potential, proved to have better performance than the standard damped sinusoid wave and the non-chopped biphasic truncated exponential pulse. This waveform was tested in a series of animal experiments in comparison with other modulated pulses, with the non-modulated waveform and the standard damped sinusoid wave. The experiments demonstrated the superiority of the modulated waveform, assessed by combining the parameters of threshold defibrillation energy and of post-shock disturbances reduction.

Animals↗

PubMedDate not supplied

Possibilities for predictive measurement of the transthoracic impedance in defibrillation.

Transthoracic electrical defibrillation is administered by high voltages and currents applied through large size electrodes. Therefore, the defibrillator load impedance becomes an essential factorfor the efficacy of the procedure. Attempts at prediction of transthoracic impedance by pre-shock measurement with low-amplitude high-frequency current have yielded apparently promising results. A reassessment was undertaken of the comparison between transthoracic impedance measured over a wide frequency range (bioimpedance spectroscopy) and measured during the shock. An estimation of the possibilities for pre-shock 'prediction ' of the impedance was performed, to allow adequate selection of the defibrillation energy or current with the intention of increasing the possibility for positive results with the first shock. Data were obtained from experimental fibrillation/defibrillation cycles on dogs andfrom cardioversion of atrial fibrillation or flutter in patients. The final results suggest that high-frequency low-amplitude impedance measurements cannot predict the corresponding value during the shock with very high accuracy, as differences up to 15-17% were found using biphasic pulses in patients. However, the method can be used for approximate assessments.

Adult↗

PubMedDate not supplied

Automatic adjustment of chopping-modulated defibrillation pulses to patient transthoracic resistance.

Defibrillation of the heart requires a high amplitude short duration current pulse to be passed through large electrodes placed on the patient's chest. The current meets a virtually active resistance, which can vary in the approximate range of 25 to 180 Omega. As the delivered current or energy depends on the resistance, several methods have been developed to reduce or compensate its influence. For example, pre-shock resistance has been measured by a high-frequency current and the current or energy set accordingly; measurements have been made from the initial tilt and the pulse durations adjusted; and pre-shock measurements have been made by a sub-shock pulse to generate an appropriately selected constant current. A method is proposed using high-frequency chopped biphasic pulses, with pulse-width and period modulation of the elementary pulses. Patient resistance is measured with the first elementary pulse and depending on its value a modulated waveform is generated, selected by a micro-controller from a preprogrammed set. Thus the selected energy is accurately delivered to the patient. In addition, this method allows the shaping of a desired mean patient current waveform, maintaining adequate charge balance between the two phases and securing an appropriate time course of the model-derived transmembrane potential.

Adult↗

PubMedDate not supplied

Defibrillator-embedded rapid recovery electrocardiogram amplifier.

One of the most important performances of the defibrillator-embedded amplifier-monitor-recorder tract, connected to defibrillator electrodes, is its rapid recovery after the application of the shock pulse. Practically near-immediate restoration of the signal trace is mandatory for studies of post-shock effects on the myocardium. Automatic analysis of the electrocardiogram signal in public-access defibrillation, aiming for about 100% correct recognition of shockable and non-shockable rhythms, now requires fast amplifier settling, as the decision time should not exceed 10-20 s. Two circuits of post-shock amplifier transient suppressors were developed with non-linear feedback, resulting in second-order high-pass filtering, with gradual return to normally accepted first-order response. Simulation and testing in real conditions resulted in recovery periods in the range of 1-2 s for an amplifier tract of 1-30 Hz bandwidth, depending on the pulse waveform and electrode type.

Amplifiers, Electronic↗