Combination of internal (epicardial) and external (transthoracic) defibrillation during heart surgery

Objectives This report describes a modified defibrillation technique during cardiac surgery using a combined internal (epicardial) and external (transthoracic) defibrillation system. Methods We routinely used 30 J (J) shock between the epicardial pad placed directly onto the right atrium and the left anterolateral transthoracic pad placed in the left anterolateral chest wall directly to the skin in the area of the cardiac apex under the nipple. Results Thirty-two patients whom developed ventricular fibrillation (VF) during surgery were managed in theatre using this method. A single 30 J shock was successfully given in 29 patients while the remaining three required an additional shock with the same amount (30 J). Conclusions We believe that this technique is safe and complications free. It is easy to perform especially in patients with difficult access such as redo operations.