PHYSICS
Power supply
Physical principles of the
defibrillator
Maheshwar Chaudhari
P M Baker
A defibrillator is a device that delivers direct electrical current
across the myocardium to cause synchronous depolarization of
the cardiac muscle, with the aim of converting a dysrhythmia into
normal sinus rhythm. It is used to treat ventricular fibrillation
(VF), which is one of the main causes of sudden death. Although
it was discovered in 1899 that a higher strength electrical signal
applied to the heart could convert VF into normal sinus rhythm,
the defibrillator was not invented until 1932.
A typical defibrillator includes a power supply, capacitor, induc-
tor, variable transformer and rectifier. Figure 1 shows the defibril-
lator circuit. The power source comes from the mains supply or
a battery.
Maheshwar Chaudhari is Specialist Registrar in Anaesthesia in the West
Midland Deanery Rotation Scheme. He qualified from the University
of Poona, India. He trained in India and Peterborough, UK. His special
interest is in the physics of anaesthesia and regional anaesthesia.
P M Baker is Consultant in Anaesthesia to Peterborough and Stamford
Hospitals NHS Foundation Trusts, UK. He qualified from the University of
Newcastle-upon-Tyne and trained in Newcastle, Sheffield and Leeds, UK.
The defibrillator circuit
Switch A
Power
source
ANAESTHESIA AND INTENSIVE CARE MEDICINE 6:12 411
The mains power supply voltage of 240 V is converted to higher
voltage (usually 5000 V) with the help of a step-up transformer. A
rectifier then converts AC voltage to DC voltage. DC energy, rather
than AC energy, is used because it is more effective, causes less
myocardial damage and is less arrhythmogenic.
Capacitor
The capacitor is the most vital part of the defibrillator. It stores
electrical energy in the form of electrical charge. A capacitor is
formed by a pair of conductors (metal plates) separated by an
insulator (a layer of air).
When switch A is activated, the current from the power supply
flows through the capacitor. The flow of current starts to build up
an electrical charge on the metal plates of the capacitor. The stored
charge (C) on the plates creates a potential difference across the
plates, which oppose the flow of current (Q). Initially the potential
difference (V) is smaller allowing more current to flow across the
capacitor plates. As the voltage of stored charge on the plates pro-
gressively rises, current flowing through the capacitor decreases.
Once the voltage of the stored charge in the capacitor equals that
of the source, current flow stops. Thus, capacitor charging is an
exponential process (Figure 2).
In the capacitor, the quantity of electrical charge stored for a
given charge potential is determined by the surface area of the
capacitor plates, the thickness of the insulating layer and the ability
of the capacitor to store charge (permitivity).
Capacitance is measured in farads (F) and is the ability of the
capacitor to hold the electrical charge.
When paddles are applied to a patient’s chest and switch B
is activated, the capacitor discharge circuit is completed. As the
current flows through the discharge circuit and between the two
paddles, electrical energy is delivered across the patient’s heart.
The quantity of current flow across the chest is partly limited by
thoracic impedance. To reduce thoracic impedance and to achieve
Switch B
Capacitor Paddles
Inductor
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 PHYSICS
Charging a capacitor
Potential difference (V)
Max
Current flow (Q)
higher peak current flow, gel pads should be applied to the chest,
paddles should be applied firmly and defibrillation should be car-
ried out in the expiratory phase of ventilation (as impedance is less
when lung volume is reduced). Capacitor discharge is associated
with a progressive fall in the potential difference (V) across the
plates. At the beginning of discharge, the potential difference is
maximum, allowing more energy to be delivered to the heart, but
as V progressively falls, this delivered energy also declines in an
exponential way.
During the discharge of a capacitor, the delivered energy falls
exponentially and some of the energy available is lost in circuit
resistance, inductor and paddles. About half of the stored energy
is delivered at the patient’s chest. Energy delivered is calculated
as:
Energy (J) = ½ × stored charge (C) × potential difference (V)
Modern defibrillators are calibrated in terms of delivered energy,
not stored energy.
Inductor
An inductor is a coil of wire. The defibrillator has an inductor in
its output circuit. During discharge of a defibrillator, current flows
through an inductor. The flow of current generates a magnetic field
around the inductor that further slows the flow of current through
it. This minimizes the rapid decay of current flow (delivered
energy) and allows it to flow for optimum duration. Effective defib-
rillation depends on sustained release of energy at the heart.
Monophasic versus biphasic energy
In a monophasic defibrillator, during discharge of the defibrilla-
ANAESTHESIA AND INTENSIVE CARE MEDICINE 6:12
Min
tor, current flows in one direction between the two plates of the
capacitor.
In a biphasic defibrillator (newer type) the current flows in
one direction for a specified duration before reversing to the other
direction for the remainder of the electrical discharge.
The biphasic waveform of energy reduces the effective energy
required for defibrillation. Thus, smaller capacitors with less bat-
tery power are required. A longer refractory period follows biphasic
shock, which helps to block recurring fibrillating waveforms.
Automated implantable cardioverter-defibrillator (AICD)
AICD is a very small defibrillator (the size of a pager) containing
its own power source in the form of a battery. It is implanted in
the body in the same way as a conventional implantable pace-
maker.
The output of the AICD may vary between 0.1 and 30 J. A
transvenously placed lead has sensing electrodes as well as shock-
ing electrodes. The sensing electrodes sense the heart rate and
analyse the morphology of complexes. The AICD can be control-
led externally with a magnet. The history of AICD activity can be
analysed by telemetry. 
FURTHER READING
Hutton P, Cooper G M, James III F M, Butterworth J F. Fundamental
principles and practice of anaesthesia. London: Martin Dunitz, 2002.
Moyle J T B, Davey A, eds. Ward’s anaesthetic equipment. London: WB
Saunders, 1998.
Sykes M K, Vickers M D, Hull C J. Principles of measurement and
monitoring in anaesthesia and intensive care. Oxford: Blackwell
Scientific Publications, 1991.
412 © 2005 The Medicine Publishing Company Ltd