Combination of internal (epicardial) and external (transthoracic) defibrillation during heart surgery

  • Georgios Theodoros KarapanagiotidisEmail author
  • Philemon Sylvester Gukop
  • Mustafa Zakkar
  • Paschalis Tossios
  • Fotios Leventis
  • Georgios Ntontos
  • Mazin Abdul Ibrahim Sarsam



This report describes a modified defibrillation technique during cardiac surgery using a combined internal (epicardial) and external (transthoracic) defibrillation system.


We routinely used 30 J (J) shock between the epicardial pad placed directly onto the right atrium and the left anterolateral transthoracic pad placed in the left anterolateral chest wall directly to the skin in the area of the cardiac apex under the nipple.


Thirty-two patients whom developed ventricular fibrillation (VF) during surgery were managed in theatre using this method. A single 30 J shock was successfully given in 29 patients while the remaining three required an additional shock with the same amount (30 J).


We believe that this technique is safe and complications free. It is easy to perform especially in patients with difficult access such as redo operations.


Arrhythmia therapy Defibrillation Re-operation Shock 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  • Georgios Theodoros Karapanagiotidis
    • 1
    • 2
    Email author
  • Philemon Sylvester Gukop
    • 1
  • Mustafa Zakkar
    • 1
  • Paschalis Tossios
    • 2
  • Fotios Leventis
    • 2
  • Georgios Ntontos
    • 2
  • Mazin Abdul Ibrahim Sarsam
    • 1
  1. 1.Cardiothoracic Surgery DepartmentSt George’s HospitalLondonUK
  2. 2.Cardiothoracic Surgery DepartmentAHEPA University HospitalThessalonikiGreece

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