How does a defibrillator work?
It delivers an electric current to the heart to restore a normal heartbeat.
The sinus node of the heart is its natural pacemaker. It sends an electrical impulse to make the heart muscles beat in rhythm. Cardiac arrest is usually caused by a life-threatening change in the rhythm of the heart (known as dysrhythmia).
When the rhythm of the heart goes awry in cardiac arrest, the defibrillator delivers a dose of electric current to the heart. The process is not fully understood, but this current depolarises a large amount of the heart muscle, which ends the dysrhythmia. Once this happens, the pacemaker of the heart can re-establish a normal rhythm.
If the shock delivered by the defibrillator isn’t strong enough, the heart might not completely repolarise, and the abnormal rhythm continues. Defibrillators monitor the new heartbeat and might advise the user to deliver another shock.
A common misconception is that defibrillators will restart a heart that is flatlining (known as asystole). But this isn’t true; once the heart is unable to create its own electrical pulse, a defibrillator will not work. Defibrillators do not jump-start the heart like jump-starting a car; they reset the natural pacemaker, like rebooting a computer.
They are straightforward for anyone to use, and it’s worth remembering that they don’t typically allow the user to administer a shock if a ‘shockable’ rhythm is not detected – so you can’t go far wrong, and speed is of the essence.
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Asked by: Felicity Brown, via email
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Dr Nish Manek is a GP in London. She completed her medical degree at Imperial College and was runner-up in the University of London Gold Medal. Manek has also developed teaching courses for Oxford Medical School, and has penned articles for The Guardian and Pulse magazine.