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CLINICAL RESEARCH: CARDIOVASCULAR CONSEQUENCES OF STUN GUN

Effects of Cocaine Intoxication on the Threshold for Stun Gun Induction of Ventricular Fibrillation

Dhanunjaya Lakkireddy, MD^_*, Donald Wallick, PhD^_*, Kay Ryschon, MS^_*, Mina K. Chung, MD, FACC^_*, Jagdish Butany, MD, David Martin, MD^_*, Walid Saliba, MD, FACC^_*, William Kowalewski, BS^_*, Andrea Natale, MD, FACC^_* and Patrick J. Tchou, MD, FACC^_*,_*

^_* Cleveland Clinic Foundation, Cleveland, Ohio
Toronto General Hospital, Toronto, Ontario, Canada.

Manuscript received January 17, 2006; revised manuscript received March 5, 2006, accepted March 20, 2006.

^_* Reprint requests and correspondence: Dr. Patrick J. Tchou, Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine/F15, 9500 Euclid Avenue, Cleveland, Ohio 44195. (Email: tchoup{at}ccf.org).

OBJECTIVES: This study sought to assess cocaine’s effects on Taser-induced ventricular fibrillation (VF) threshold in a pig model.

BACKGROUND: Stun guns are increasingly used by law enforcement officials to restrain violent subjects, who are frequently intoxicated with cocaine and other drugs of abuse. The interaction of cocaine and the stun gun on VF induction is unknown.

METHODS: We tested five adult pigs using a custom device built to deliver multiples of standard neuromuscular incapacitating (NMI) discharge that matched the waveform of a commercially available electrical stun gun (Taser X-26, Taser International, Scottsdale, Arizona). The NMI discharges were applied in a step-up and step-down fashion at 5 body locations. End points included determination of maximum safe multiple, minimum VF-inducing multiple, and ventricular fibrillation threshold (VFT) before and after cocaine infusion.

RESULTS: Standard NMI discharges (x1) did not cause VF at any of the 5 locations before or after cocaine infusion. The maximum safe multiple, minimum VF-inducing multiple, and VFT of NMI application increased with increasing electrode distance from the heart. There was a 1.5- to 2-fold increase in these values at each position after cocaine infusion, suggesting decreased cardiac vulnerability for VF. Cocaine increased the required strength of NMI discharge that caused 2:1 or 3:1 ventricular capture ratios at all of the positions. No significant changes in creatine kinase-MB and troponin-I were seen.

CONCLUSIONS: Cocaine increased the VFT of NMI discharges at all dart locations tested and reduced cardiac vulnerability to VF. The application of cocaine increased the safety margin by 50% to 100% above the baseline safety margin.

Abbreviations and Acronyms   CK = creatine kinase   ECG = electrocardiogram   maxSM = maximum safe multiple   minVFIM = minimum ventricular fibrillation-inducing multiple   NMI = neuromuscular incapacitating   PMI = point of maximum impulse   SN = sternal notch   VF = ventricular fibrillation   VFT = ventricular fibrillation threshold

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