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CLINICAL STUDIES

Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation

Suneet Mittal, MD^a, Shervin Ayati, MSEE^*, Kenneth M. Stein, MD, FACC^a, Bradley P. Knight, MD, Fred Morady, MD, FACC, David Schwartzman, MD, FACC, Doris Cavlovich, RN, BSN, Edward V. Platia, MD, FACC, Hugh Calkins, MD, FACC^||, Patrick J. Tchou, MD, FACC^||, John M. Miller, MD, FACC^#, J. Marcus Wharton, MD^**, Ruey J. Sung, MD, FACC, David J. Slotwiner, MD^a, Steven M. Markowitz, MD, FACC^a, Bruce B. Lerman, MD, FACC^a for the ZOLL Investigators

^a New York Hospital–Cornell Medical Center, New York, New York, USA
^* Zoll Medical Corporation, Burlington, Massachusetts, USA
University of Michigan Medical Center, Ann Arbor, Michigan, USA
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Washington Hospital Center, Washington, DC, USA
^|| Johns Hopkins University Medical Center, Baltimore, Maryland, USA
^|| Cleveland Clinic Foundation, Cleveland, Ohio, USA
^# Temple University Medical Center, Philadelphia, Pennsylvania, USA
^** Duke University Medical Center, Durham, North Carolina, USA
Stan-ford University Hospital, Palo Alto, California, USA

Manuscript received February 11, 1999; revised manuscript received June 18, 1999, accepted June 30, 1999.

Reprint requests and correspondence: Dr. Bruce B. Lerman, Division of Cardiology, The New York Hospital–Cornell Medical Center, 525 East 68th Street, Starr 4, New York, New York 10021
blerman{at}mail.med.cornell.edu

OBJECTIVES

We compared the efficacy of a novel rectilinear biphasic waveform, consisting of a constant current first phase, with a damped sine wave monophasic waveform during transthoracic defibrillation.

BACKGROUND

Multiple studies have shown that for endocardial defibrillation, biphasic waveforms have a greater efficacy than monophasic waveforms. More recently, a 130-J truncated exponential biphasic waveform was shown to have equivalent efficacy to a 200-J damped sine wave monophasic waveform for transthoracic ventricular defibrillation. However, the optimal type of biphasic waveform is unknown.

METHODS

In this prospective, randomized, multicenter trial, 184 patients who underwent ventricular defibrillation were randomized to receive a 200-J damped sine wave monophasic or 120-J rectilinear biphasic shock.

RESULTS

First-shock efficacy of the biphasic waveform was significantly greater than that of the monophasic waveform (99% vs. 93%, p = 0.05) and was achieved with nearly 60% less delivered current (14 ± 1 vs. 33 ± 7 A, p < 0.0001). Although the efficacy of the biphasic and monophasic waveforms was comparable in patients with an impedance <70 (100% [biphasic] vs. 95% [monophasic], p = NS), the biphasic waveform was significantly more effective in patients with an impedance 70 (99% [biphasic] vs. 86% [monophasic], p = 0.02).

CONCLUSIONS

This study demonstrates a superior efficacy of rectilinear biphasic shocks as compared with monophasic shocks for transthoracic ventricular defibrillation, particularly in patients with a high transthoracic impedance. More important, biphasic shocks defibrillated with nearly 60% less current. The combination of increased efficacy and decreased current requirements suggests that biphasic shocks as compared with monophasic shocks are advantageous for transthoracic ventricular defibrillation.

Abbreviations and Acronyms   ICD = implantable cardioverter-defibrillator   LV = left ventricle or ventricular

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