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Static filling pressure in patients during induced ventricular fibrillation

¹Research Group Experimental Surgery and ²Clinic of Thoracic and Cardiovascular Surgery, Department of Surgery I, University Hospital Duesseldorf, Dusseldorf D 40225; ³Institute of Pathophysiology, University Hospital Essen, D 45147 Essen, Germany; and ⁴Department of Radiology, Tulane University, New Orleans, Louisiana 70118

Submitted 26 June 2003 ; accepted in final form 30 July 2003

The static pressure resulting after the cessation of flow is thought to reflect the filling of the cardiovascular system. In the past, static filling pressures or mean circulatory filling pressures have only been reported in experimental animals and in human corpses, respectively. We investigated arterial and central venous pressures in supine, anesthetized humans with longer fibrillation/defibrillation sequences (FDSs) during cardioverter/defibrillator implantation. In 82 patients, the average number of FDSs was 4 ± 2 (mean ± SD), and their duration was 13 ± 2 s. In a total of 323 FDSs, arterial blood pressure decreased with a time constant of 2.9 ± 1.0 s from 77.5 ± 34.4 to 24.2 ± 5.3 mmHg. Central venous pressure increased with a time constant of 3.6 ± 1.3 s from 7.5 ± 5.2 to 11.0 ± 5.4 mmHg (36 points, 141 FDS). The average arteriocentral venous blood pressure difference remained at 13.2 ± 6.2 mmHg. Although it slowly decreased, the pressure difference persisted even with FDSs lasting 20 s. Lack of true equilibrium pressure could possibly be due to a waterfall mechanism. However, waterfalls were identified neither between the left ventricle and large arteries nor at the level of the diaphragm in supine patients. We therefore suggest that static filling pressures/mean circulatory pressures can only be directly assessed if the time after termination of cardiac pumping is adequate, i.e., >20 s. For humans, such times are beyond ethical options.

mean circulatory (filling) pressure; vascular waterfall; implantable cardioverter/defibrillator; defibrillation threshold testing

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