The automatic internal defibrillator delivers a low-energy shock directly to the heart. Optimal strategies for these shock deliveries are determined by studying a three-dimensional computer model of the electric fields produced by initial defibillation electrodes. A finite-element analysis technique is used to calculate energy and current density distributions in three commonly used electrode configurations: (1) patch-patch (PP), (2) catheter-patch (CP), and (3) catheter-catheter (CC). analysis of these simulations indicates that : (1) the PP and CP configurations are more effective at channeling energy to the myocardium than the CC configuration; (2) small electrodes and the edges of the electrodes give rise to high local current densities which might cause damage to the myocardium: (3) energy delivered to the myocardium is not significantly altered for different electrode placements tested; (4) electrode size influences current density distribution, especially near the electrodes; and (5) energy distribution is sensitive to the relative conductances of the myocardial tissue and blood.
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