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Comparison of monophasic and biphasic defibrillating pulse waveforms for transthoracic cardioversion

  • H. Leon Greene
    Correspondence
    Address for reprints: H. Leon Greene, MD, Division of Cardiology, Harborview Medical Center, 325 9th Avenue (ZA-35), Seattle, Washington, 98104-2499.
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • John P. DiMarco
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Peter J. Kudenchuk
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Melvin M. Scheinman
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Anthony S.L. Tang
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Michael J. Reiter
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Debra S. Echt
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Peter D. Chapman
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Mohammad R. Jazayeri
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Fred W. Chapman
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Mahboob Ahmed
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Jeffrey L. Johnson
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • Robert A. Niskanen
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
  • The Biphasic Waveform Defibrillation Investigators
    Affiliations
    From the University of Washington, Seattle, Washington, USA

    From the University of Virginia, Charlottesville, Virginia, USA

    From the University of California, San Francisco, California, USA

    From the University of Ottawa, Ottawa, Ontario, Canada

    From the University of Colorado, Denver, Colorado, USA

    From the Vanderbilt University, Nashville, Tennessee, USA

    From the St. Joseph's Hospital, Milwaukee, Wisconsin, USA

    From the Mt. Sinai Medical Center, Milwaukee, Wisconsin, USA

    From the Physio-Control Corporation, Redmond, Washington, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      All transthoracic defibrillators on the US market use nominally monophasic shock waveforms. However, biphasic waveforms have a lower defibrillation threshold than monophasic waveforms for transthoracic defibrillation of animals and for defibrillation of humans by implantable cardioverter defibrillators. The relative efficacies of Edmark monophasic and Gurvich biphasic transthoracic cardioversion waveforms (200 J into 50 Ω) were compared for transthoracic cardioversion in 171 patients undergoing electrophysiologic study for evaluation of ventricular arrhythmias. Patients were randomized in a blinded fashion to receive either a monophasic or a biphasic waveform for the initial shock for conversion of induced ventricular arrhythmias (ventricular fibrillation [VF] = 53, monomorphic ventricular tachycardia [VT] = 80, polymorphic VT = 30, ventricular flutter = 8). Delivered energies for the Edmark and Gurvich waveforms were 215 ± 11 and 171 ± 11 J, respectively. There were no significant differences in patient characteristics, use of antiarrhythmic agents, arrhythmia cycle length, or duration of arrhythmia prior to shock for monophasic and biphasic waveform groups. The first shock for all arrhythmias was successful in 75 of 88 patients (85.2%) for the monophasic waveform compared with 81 of 83 patients (97.6%) for the biphasic waveform, p = 0.0054. The first shock for VF was successful in 22 of 28 patients (78.6%) for the monophasic waveform compared with 25 of 25 (100%) for the biphasic waveform, p = 0.0241. The Gurvich biphasic waveforms delivering a mean of 171 J were superior to Edmark monophasic waveforms delivering a mean of 215 J for transthoracic cardioversion of arrhythmias of short duration. This finding may have important implications for the development of future transthoracic defibrillators.
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