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Direct current electric shock has been widely used in the past 2 decades to convert supraventricular and ventricular dysrhythmias to sinus mechanism. Initial reports stressed the benign nature of this treatment. Subsequently, it was demonstrated that cardioversion could lead to potentially serious complications. Much has been learned about indications, contraindications, and prevention of complications in utilization of direct current electric shock for the treatment of cardiac dysrhythmias. Our experience of more than 10 years with cardioversion at The Cleveland Clinic Foundation is discussed.

Historical considerations

The use of electrical energy for termination of ventricular fibrillation dates back to the turn of the century. In 1899, Prevost and Battelli1 applied electrical current directly to the hearts of dogs to induce ventricular fibrillation, and at the same time observed that similar electrical discharges were capable of terminating ventricular fibrillation. In 1940, Wiggers2 confirmed the effectiveness of electrical current in defibrillating the exposed heart after a series of extensive investigations. These studies resulted in the first successful defibrillation of the human heart by Beck et al3 in 1947; the patient recovered completely. Alexander et al,4 in 1961, were the first to employ A-C electricity electively in patients with coronary artery disease to terminate an episode of ventricular tachycardia which was found to be resistant to antiarrhythmic drugs. This successful transthoracic use of alternating current shock led to a new era in the treatment of cardiac dysrhythmias. After extensive experiments in the animal laboratory, synchronized direct current cardioversion to avoid the vulnerable period in. . .



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