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

Suneet Mittal, Shervin Ayati, Kenneth M. Stein, Bradley P. Knight, Fred Morady, David Schwartzman, Doris Cavlovich, Edward V. Platia, Hugh Calkins, Patrick J. Tchou, John Miller, J. Marcus Wharton, Ruey J. Sung, David J. Slotwiner, Steven M. Markowitz, Bruce B. Lerman

Research output: Contribution to journalArticle

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Abstract

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 Ω (100% [biphasic] vs. 95% [monophasic], p = NS), the biphasic waveform was significantly more effective in patients with an impedance ≥70 Ω (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 advantageous for transthoracic ventricular defibrillation.

Original languageEnglish (US)
Pages (from-to)1595-1601
Number of pages7
JournalJournal of the American College of Cardiology
Volume34
Issue number5
DOIs
StatePublished - Nov 1 1999
Externally publishedYes

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Shock
Electric Impedance
Impedance Cardiography
Multicenter Studies

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  • Nursing(all)

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Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation. / Mittal, Suneet; Ayati, Shervin; Stein, Kenneth M.; Knight, Bradley P.; Morady, Fred; Schwartzman, David; Cavlovich, Doris; Platia, Edward V.; Calkins, Hugh; Tchou, Patrick J.; Miller, John; Marcus Wharton, J.; Sung, Ruey J.; Slotwiner, David J.; Markowitz, Steven M.; Lerman, Bruce B.

In: Journal of the American College of Cardiology, Vol. 34, No. 5, 01.11.1999, p. 1595-1601.

Research output: Contribution to journalArticle

Mittal, S, Ayati, S, Stein, KM, Knight, BP, Morady, F, Schwartzman, D, Cavlovich, D, Platia, EV, Calkins, H, Tchou, PJ, Miller, J, Marcus Wharton, J, Sung, RJ, Slotwiner, DJ, Markowitz, SM & Lerman, BB 1999, 'Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation', Journal of the American College of Cardiology, vol. 34, no. 5, pp. 1595-1601. https://doi.org/10.1016/S0735-1097(99)00363-0
Mittal, Suneet ; Ayati, Shervin ; Stein, Kenneth M. ; Knight, Bradley P. ; Morady, Fred ; Schwartzman, David ; Cavlovich, Doris ; Platia, Edward V. ; Calkins, Hugh ; Tchou, Patrick J. ; Miller, John ; Marcus Wharton, J. ; Sung, Ruey J. ; Slotwiner, David J. ; Markowitz, Steven M. ; Lerman, Bruce B. / Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation. In: Journal of the American College of Cardiology. 1999 ; Vol. 34, No. 5. pp. 1595-1601.
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abstract = "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 Ω (100{\%} [biphasic] vs. 95{\%} [monophasic], p = NS), the biphasic waveform was significantly more effective in patients with an impedance ≥70 Ω (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 advantageous for transthoracic ventricular defibrillation.",
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T1 - Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation

AU - Mittal, Suneet

AU - Ayati, Shervin

AU - Stein, Kenneth M.

AU - Knight, Bradley P.

AU - Morady, Fred

AU - Schwartzman, David

AU - Cavlovich, Doris

AU - Platia, Edward V.

AU - Calkins, Hugh

AU - Tchou, Patrick J.

AU - Miller, John

AU - Marcus Wharton, J.

AU - Sung, Ruey J.

AU - Slotwiner, David J.

AU - Markowitz, Steven M.

AU - Lerman, Bruce B.

PY - 1999/11/1

Y1 - 1999/11/1

N2 - 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 Ω (100% [biphasic] vs. 95% [monophasic], p = NS), the biphasic waveform was significantly more effective in patients with an impedance ≥70 Ω (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 advantageous for transthoracic ventricular defibrillation.

AB - 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 Ω (100% [biphasic] vs. 95% [monophasic], p = NS), the biphasic waveform was significantly more effective in patients with an impedance ≥70 Ω (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 advantageous for transthoracic ventricular defibrillation.

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