Vector Change and Dual Sequence D-Fibs in Refractory F

When patients present in VF, actually the first three shocks, their survival is not bad with standard AL defibrillation. When you go to shocks four to ten, or these refractory cases, survival drops to about 12.5%. That's reflected in our huge Swedish registry that looked at this particular question. And it matches our registry work as well. So one needs to start thinking, are there alternative strategies that we can use in refractive F to improve survival? Two of the concepts that we thought about was a concept of vector change, so changing the pads from the classic AL position to the AP position,. The second one being double sequential external defibrillation, the application of