Defibrillation of high-risk patients during coronary angiography using self-adhesive, preapplied electrode pads

Direct-current shocks for ventricular fibrillation or ventricular tachycardia have traditionally been administered using hand-held "paddle" electrodes. Hurried, incorrect paddle electrode placement during emergency cardioversion or defibrillation and poor contact between the paddle electrode and skin may be responsible for failure of electrical shocks to terminate arrhythmias.^1,2 Additionally, when shocks are given in the cardiac catheterization laboratory, the need to remove sterile drapes and radiographic equipment and the presence of intravascular (and often intracoronary) catheters makes defibrillation during angiography at least cumbersome, and may cause important delays in shock delivery. Moreover, sterile fields are often contaminated during defibrillation attempts using handheld paddle electrodes. Self-adhesive, preapplied electrode pads have been successfully used in place of hand-held paddle electrodes for elective cardioversion and for out-of-hospital defibrillation. 3,4 However, the foil electrodes of such preapplied defibrillation pads may interfere with radiographic visualization of the heart. Recently, to overcome this potential visualization problem, a new, commercially available version of the self-adhesive electrode pads was introduced. The modified self-adhesive pads consist of an apical electrode, which is half-circular in order to avoid obscuring the heart, and a fully circular electrode, which is placed in the right parasterngl position. We report our experience with use of these self-adhesive, preapplied electrodes during angiographic procedures in high-risk patients in whom serious ventricular arrhythmias requiring direct-current shocks are likely to develop.