Reduction of defibrillator shock related pain by a tetanizing prepulse

Defibrillator shocks are painful, mostly due to the associated skeletal muscle stimulation. A novel method for minimizing defibrillator shock associated pain has been proposed by a porcine study [1]. A high frequency alternating current prepulse is delivered just before the actual defibrillator shock in this model. Limb acceleration and rate of force development was used as a surrogate of pain in the animal model. There was no difference in the defibrillation threshold with true biphasic shocks and shocks preceded by a tetanizing prepulse. Still there was almost three fourth reduction in peak acceleration and rate of force development with a prepulse. This would suggest that implantable defibrillator shock associated pain could be reduced by a tetanizing prepulse. Of course human studies are needed before actual clinical implementation.


1. Hunter DW, Tandri H, Halperin H, Tung L, Berger RD. Tetanizing prepulse: A novel strategy to mitigate implantable cardioverter-defibrillator shock-related pain. Heart Rhythm. 2016 Jan 6. pii: S1547-5271(15)01682-3.