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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

View larger version (11K): [in a new window]   Figure 1 Defibrillation waveforms. Top, Representative 200-J damped sine wave shock delivered across a 50- load. Bottom, Representative 120-J rectilinear biphasic waveform delivered across a 50- load.

View larger version (19K): [in a new window]   Figure 2 Monophasic waveform protocol. The initial shock was a 200-J damped sine wave monophasic shock. If the initial shock failed to defibrillate, the patient received a 300-J shock, and if that was unsuccessful, a 360-J shock was delivered. If all three monophasic shocks were unsuccessful, a 170-J biphasic shock was delivered.

View larger version (18K): [in a new window]   Figure 3 Biphasic waveform protocol. The initial shock was a 120-J biphasic shock. If the initial shock failed to defibrillate, the patient received a 150-J shock, and if that was unsuccessful, a 170-J shock was delivered. If all three biphasic shocks were unsuccessful, a 360-J damped sine wave monophasic shock was delivered. In addition, this protocol was applied to all patients, regardless of initial randomization, when an additional induction of ventricular fibrillation was required.