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Triphasic waveforms are superior to biphasic waveforms for transthoracic defibrillation

Experimental studies

Yi Zhang, MD, PhD^*, R. S. Ramabadran, MD, PhD^*, Kimberly A. Boddicker, MD^*, Imran Bawaney, MD^*, Loyd R. Davies, BS^*, M. Bridget Zimmerman, PhD^*, Scott Wuthrich, MSEE, Janice L. Jones, PhD and Richard E. Kerber, MD, FACC^*,*

^* Cardiovascular Center, College of Medicine, University of Iowa, Iowa City, Iowa, USA
Philips Medical Systems, Andover, Massachusetts, USA
Department of Physiology and Biophysics, Georgetown University, Washington, DC, USA
Department of Physiology at the Veterans Affairs Medical Center, Washington, DC, USA

View larger version (26K): [in a new window]   Figure 1 Examples of biphasic and triphasic waveforms: biphasic equal-duration pulses (A), triphasic equal-duration pulses (B), biphasic equal-energy pulses (C), and triphasic equal-energy pulses (D).

View larger version (19K): [in a new window]   Figure 2 Shock success of triphasic (4.8/4.8/4.8 ms) and biphasic (7.2/7.2 ms) waveform shocks of equal-duration pulses at five intervals of actually delivered energy to the animals in part I. Triphasic waveform shocks achieved higher success rates at the intervals of 40 J, 40 to <50 J, and 50 to <65 J (n = 32).

View larger version (19K): [in a new window]   Figure 3 Shock success of triphasic (5/5/5 ms) and biphasic (5/5 ms) waveform shocks of equal-duration pulses at five intervals of actually delivered energy to the animals in parts II and III. Triphasic waveform shocks achieved higher success rates at the intervals of 40 to <50 J and 50 to <65 J (n = 27).

View larger version (17K): [in a new window]   Figure 4 Shock success of triphasic (2.0/3.2/9.2 ms) and biphasic (3.3/11.1 ms) waveform shocks of equal-energy pulses at three intervals of actually delivered energy to the animals in part I. Triphasic waveform shocks achieved higher success rates at the intervals of 40 J, 40 to <65 J, and 65 J (n = 9).

View larger version (19K): [in a new window]   Figure 5 Mean current versus shock success of triphasic (4.8/4.8/4.8 ms) and biphasic (7.2/7.2 ms) waveform shocks of equal-duration pulses for all pigs in part I. Triphasic shocks with mean currents of 6 and 8.4 Amperes, generated by selected energy shocks of 50 and 100 J, achieved higher success than biphasic shocks (n = 32).