Optimization of cardiac defibrillation by three-dimensional finite element modeling of the human thorax.

The goal of this study was to determine the optimal electrode placement and size to minimize myocardial damage during defibrillation while rendering refractory a critical mass of cardiac tissue of 100%. For this purpose, we developed a 3-D finite element model with 55,388 nodes, 50,913 hexahedral elements, and simulated 16 different organs and tissues, as well as the properties of the electrolyte. The model used a nonuniform mesh with an average spatial resolution of 0.8 cm in all three dimensions. To validate this model, we measured the voltage across 3-cm2 Ag-AgCl electrodes when currents of 5 mA at 50 kHz were injected into a human subject's thorax through the same electrodes. For the same electrode placements and sizes and the same injected current, the finite element analysis produced results in good agreement with the experimental data. For the optimization of defibrillation, we tested 12 different electrode placements and seven different electrode sizes. The finite element analyses showed that the anterior-posterior electrode placement and an electrode size of about 90 cm2 offered the least chance of potential myocardial damage and required a shock energy of less than 350 J for 5-ms defibrillation pulses to achieve 100% critical mass. For comparison, the average cross-sectional area of the heart is approximately 48 cm2, about half of the optimal area. A second best electrode placement was with the defibrillation electrodes on the midaxillary lines under the armpits. Although this placement had higher chances of producing cardiac damage, it required less shock energy to achieve 100% critical mass.