Nature and Determinants of Skin “Burns” After Transthoracic Cardioversion

Skin biopsies obtained 24 hours after elective cardioversion of 30 patients showed variable epidermal necrosis and upper dermal perivascular inflammation, most noticeable in patients receiving high individual peak (≥300 J) and cumulative (≥350 J) shock energies. Thus, damped sine wave shocks cause skin injury—first degree burns—the severity of which is a function of peak and cumulative shock energy.