Evaluation of the Skin-To-Heart Distance in the Standing Adult by Two-Dimensional Echocardiography

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An electromuscular incapacitating device (EMD) delivers pulses of high-voltage electricity, causing strong muscle contraction. Data from a pig model suggest that an EMD dart tip placed within 17 mm of the epicardial surface can cause ventricular fibrillation. The current study estimates minimum skin-to-heart distance in the adult, to determine whether individuals might be at risk for ventricular fibrillation from an EMD.


We performed 2-dimensional echocardiograms in 150 standing adults in the parasternal, apical, and subcostal views. From each view, the shortest linear skin-to-heart distance was measured.


Average skin-to-heart distances were: parasternal 32.1 ± 7.9 mm; apical 31.3 ± 11.3 mm; and subcostal 70.8 ± 22.3 mm. There were 9 (6%) individuals with a skin-to-heart distance less than or equal to 17 mm. The skin-to-heart distance was significantly correlated with body mass index: parasternalr= 0.57, apicalr= 0.55 (P< .0001).


An EMD dart penetrating the skin directly over the heart might put individuals at risk for ventricular fibrillation.

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