A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans
GH Bardy,
TD Ivey,
MD Allen,
G Johnson,
R Mehra,
and
HL Greene
Department of Medicine, University of Washington, Seattle 98195.
Biphasic waveforms have been suggested as a superior waveform for ventricular defibrillation. To test this premise, a prospective randomized intraoperative evaluation of defibrillation efficacy of monophasic and biphasic waveform pulses was performed in 22 survivors of out of hospital ventricular fibrillation who were undergoing cardiac surgery for implantation of an automatic defibrillator. The initial waveform used in a patient for defibrillation testing, either monophasic or biphasic, was randomly selected. Subsequently, each patient served as his or her own control for defibrillation testing of the other waveform. The defibrillation threshold was defined as the lowest pulse amplitude that would effectively terminate ventricular fibrillation with a single discharge delivered 10 s after initiation of an episode of ventricular fibrillation induced with alternating current. Each defibrillation pulse was recorded oscilloscopically, and defibrillation pulse voltage, current, resistance and stored energy were measured. Fifteen (68%) of the 22 patients had a lower defibrillation threshold with the biphasic pulse, 3 (14%) had a lower threshold with the monophasic pulse and 4 (18%) had equal defibrillation thresholds (within 1.0 J) regardless of waveform. The mean leading edge defibrillation threshold voltage was 317 +/- 105 V when the monophasic pulse was used and 267 +/- 102 V (16% less) when the biphasic pulse was used (p = 0.008). Mean leading edge defibrillation threshold current was 7.9 +/- 3.7 A when the monophasic pulse was used and 6.8 +/- 3.8 A (14% less) when the biphasic pulse was used (p = 0.051).(ABSTRACT TRUNCATED AT 250 WORDS)
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39(2):
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|
 |
|

|
 |

|
 |
 
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34(5):
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|
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 |
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|
 |
|

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Relative Efficacy of Monophasic and Biphasic Waveforms for Transthoracic Defibrillation After Short and Long Durations of Ventricular Fibrillation
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98(20):
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|
 |
|

|
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Approaches to modern management of cardiac arrest
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 |
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|
 |

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 |
 
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97(20):
2073 - 2078.
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|
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|

|
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|
 |
|

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96(10):
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|
 |
|

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|
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95(7):
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|
 |
|

|
 |

|
 |
 
R. A. S. Cooper, E. E. Johnson, and J. M. Wharton
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Circulation,
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95(6):
1487 - 1496.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
G. H. Bardy, F. E. Marchlinski, A. D. Sharma, S. J. Worley, R. M. Luceri, R. Yee, B. D. Halperin, C. L. Fellows, T. S. Ahern, D. A. Chilson, et al.
Multicenter Comparison of Truncated Biphasic Shocks and Standard Damped Sine Wave Monophasic Shocks for Transthoracic Ventricular Defibrillation
Circulation,
November 15, 1996;
94(10):
2507 - 2514.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
C. D. Swerdlow, W. Fan, and J. E. Brewer
Charge-Burping Theory Correctly Predicts Optimal Ratios of Phase Duration for Biphasic Defibrillation Waveforms
Circulation,
November 1, 1996;
94(9):
2278 - 2284.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
F. J. Venditti, R. M. John, M. Hull, G. H. Tofler, D. M. Shahian, and D. T. Martin
Circadian Variation in Defibrillation Energy Requirements
Circulation,
October 1, 1996;
94(7):
1607 - 1612.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
B. E. Gliner, T. E. Lyster, S. M. Dillion, and G. H. Bardy
Transthoracic Defibrillation of Swine With Monophasic and Biphasic Waveforms
Circulation,
September 15, 1995;
92(6):
1634 - 1643.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
J. S. Lawton, K. A. Ellenbogen, M. A. Wood, B. S. Stambler, J. A. Spratt, A. S. Wechsler, and R. J. Damiano Jr
Clinical Experience With Nonthoracotomy Cardioverter Defibrillators
Ann. Thorac. Surg.,
May 1, 1995;
59(5):
1092 - 1098.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
G. H. Bardy, B. E. Gliner, P. J. Kudenchuk, J. E. Poole, G. L. Dolack, G. K. Jones, J. Anderson, C. Troutman, and G. Johnson
Truncated Biphasic Pulses for Transthoracic Defibrillation
Circulation,
March 15, 1995;
91(6):
1768 - 1774.
[Abstract]
[Full Text]
|
 |
|
|