A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans

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)

This article has been cited by other articles:

				D. A.M.J. Theuns, T. Szili-Torok, and L. J. Jordaens Defibrillation efficacy testing: Long-term follow-up and mortality Europace, January 1, 2005; 7(6): 509 - 515. [Abstract] [Full Text] [PDF]

				J. W. Mason The truth about shocking ventricular tachycardia and ventricular fibrillation J. Am. Coll. Cardiol., August 18, 2004; 44(4): 853 - 854. [Full Text] [PDF]

				N. Madan, J. W. Gaynor, R. Tanel, M. Cohen, S. Nicholson, V. Vetter, and L. Rhodes Single-finger subcutaneous defibrillation lead and "active can": a novel minimally invasive defibrillation configuration for implantable cardioverter-defibrillator implantation in a young child J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1657 - 1659. [Full Text] [PDF]

				M Scholten, T Szili-Torok, P Klootwijk, and L Jordaens Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation Heart, September 1, 2003; 89(9): 1032 - 1034. [Abstract] [Full Text] [PDF]

				G. P. Walcott, C. R. Killingsworth, W. M. Smith, and R. E. Ideker Biphasic waveform external defibrillation thresholds for spontaneous ventricular fibrillation secondary to acute ischemia J. Am. Coll. Cardiol., January 16, 2002; 39(2): 359 - 365. [Abstract] [Full Text] [PDF]

				P. Ricard, S. Levy, G. Boccara, E. Lakhal, and G. Bardy External cardioversion of atrial fibrillation: comparison of biphasic vs monophasic waveform shocks Europace, January 1, 2001; 3(2): 96 - 99. [Abstract] [PDF]

				T. Schneider, P. R. Martens, H. Paschen, M. Kuisma, B. Wolcke, B. E. Gliner, J. K. Russell, W. D. Weaver, L. Bossaert, and D. Chamberlain Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims Circulation, October 10, 2000; 102(15): 1780 - 1787. [Abstract] [Full Text] [PDF]

				C. T. Leng, N. A. Paradis, H. Calkins, R. D. Berger, A. C. Lardo, K. C. Rent, and H. R. Halperin Resuscitation After Prolonged Ventricular Fibrillation With Use of Monophasic and Biphasic Waveform Pulses for External Defibrillation Circulation, June 27, 2000; 101(25): 2968 - 2974. [Abstract] [Full Text] [PDF]

				S. Mittal, S. Ayati, K. M. Stein, D. Schwartzman, D. Cavlovich, P. J. Tchou, S. M. Markowitz, D. J. Slotwiner, M. A. Scheiner, and B. B. Lerman Transthoracic Cardioversion of Atrial Fibrillation : Comparison of Rectilinear Biphasic Versus Damped Sine Wave Monophasic Shocks Circulation, March 21, 2000; 101(11): 1282 - 1287. [Abstract] [Full Text] [PDF]

				R. Gradaus, D. Bocker, A. Dorszewski, B. Lamp, D. Hammel, G. Breithardt, and M. Block Fractally coated defibrillation electrodes: Is an improvement in defibrillation threshold possible? Europace, January 1, 2000; 2(2): 154 - 159. [Abstract] [PDF]

				S. Mittal, S. Ayati, K. M. Stein, B. P. Knight, F. Morady, D. Schwartzman, D. Cavlovich, E. V. Platia, H. Calkins, P. J. Tchou, et al. Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1595 - 1601. [Abstract] [Full Text] [PDF]

				W. Tang, M. H. Weil, S. Sun, H. Yamaguchi, H. P. Povoas, A. M. Pernat, and J. Bisera The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function J. Am. Coll. Cardiol., September 1, 1999; 34(3): 815 - 822. [Abstract] [Full Text] [PDF]

				L. A. Pires, M. H. Lehmann, R. T. Steinman, J. J. Baga, C. D. Schuger, and Participating Investigators Sudden death in implantable cardioverter-defibrillator recipients: clinical context, arrhythmic events and device responses J. Am. Coll. Cardiol., January 1, 1999; 33(1): 24 - 32. [Abstract] [Full Text] [PDF]

				S. Windecker, R. E. Ideker, V. J. Plumb, G. N. Kay, G. P. Walcott, and A. E. Epstein The influence of ventricular fibrillation duration on defibrillation efficacy using biphasic waveforms in humans J. Am. Coll. Cardiol., January 1, 1999; 33(1): 33 - 38. [Abstract] [Full Text] [PDF]

				G. P. Walcott, S. B. Melnick, F. W. Chapman, J. L. Jones, W. M. Smith, and R. E. Ideker Relative Efficacy of Monophasic and Biphasic Waveforms for Transthoracic Defibrillation After Short and Long Durations of Ventricular Fibrillation Circulation, November 17, 1998; 98(20): 2210 - 2215. [Abstract] [Full Text] [PDF]

				A A J Adgey and P W Johnston Approaches to modern management of cardiac arrest Heart, October 1, 1998; 80(4): 397 - 401. [Full Text]

				P. Schauerte, F. A. Schondube, M. Grossmann, H. Dorge, F. Stein, B. Dohmen, A. Moumen, K. Erena, B. J. Messmer, P. Hanrath, et al. Influence of Phase Duration of Biphasic Waveforms on Defibrillation Energy Requirements With a 70-µF Capacitance Circulation, May 26, 1998; 97(20): 2073 - 2078. [Abstract] [Full Text] [PDF]

				R. O. Cummins, M. F. Hazinski, R. E. Kerber, P. Kudenchuk, L. Becker, G. Nichol, B. Malanga, T. P. Aufderheide, E. M. Stapleton, K. Kern, et al. Low-Energy Biphasic Waveform Defibrillation: Evidence-Based Review Applied to Emergency Cardiovascular Care Guidelines : A Statement for Healthcare Professionals From the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation Circulation, April 28, 1998; 97(16): 1654 - 1667. [Full Text] [PDF]

				M. J. Niebauer, B. Wilkoff, Y. Yamanouchi, T. Mazgalev, K. Mowrey, and P. Tchou Iridium Oxide–Coated Defibrillation Electrode : Reduced Shock Polarization and Improved Defibrillation Efficacy Circulation, November 18, 1997; 96(10): 3732 - 3736. [Abstract] [Full Text]

				G. Tomassoni, K. Newby, S. Deshpande, K. Axtell, J. Sra, M. Akhtar, and A. Natale Defibrillation Efficacy of Commercially Available Biphasic Impulses in Humans : Importance of Negative-Phase Peak Voltage Circulation, April 1, 1997; 95(7): 1822 - 1826. [Abstract] [Full Text]

				R. A. S. Cooper, E. E. Johnson, and J. M. Wharton Internal Atrial Defibrillation in Humans : Improved Efficacy of Biphasic Waveforms and the Importance of Phase Duration Circulation, March 18, 1997; 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]