Biphasic versus monophasic shock waveform for conversion of atrial fibrillation

Page, Richard L.; Kerber, Richard E.; Russell, James K.; Trouton, Tom G.; Waktare, Johan; Gallik, Donna M.; Olgin, Jeff E.; Ricard, Philippe; Dalzell, G. W. N.; Reddy, Ramakota K.; Lazzara, Ralph; Lee, Kerry; Carlson, Mark D.; Halperin, Blair D.; Bardy, Gust H.

doi:10.1016/s0735-1097(02)01898-3

Cited by 198 publications

(44 citation statements)

References 15 publications

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“…To reduce symptoms and prevent disease progression, direct current cardioversion is a widely used procedure for patients with AF 2. During the past decades, biphasic waveforms have proven superior to monophasic waveforms for cardioversion of supraventricular tachycardia in several randomized studies 3, 4, 5, 6. In these studies, more patients were restored to sinus rhythm when receiving biphasic shocks compared with monophasic shocks, using less total delivered energy.…”

Section: Introductionmentioning

confidence: 99%

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Schmidt

Lauridsen

Adelborg

et al. 2017

JAHA

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BackgroundSeveral different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB shocks with biphasic truncated exponential (BTE) shocks in patients undergoing cardioversion of atrial fibrillation or ‐flutter.Methods and ResultsThis prospective, randomized study included patients admitted for elective direct current cardioversion. Patients were randomized to receive cardioversion using either PB or BTE shocks. We used escalating shocks until sinus rhythm was obtained or to a maximum of 4 shocks. Patients randomized to PB shocks received 90, 120, 150, and 200 J and patients randomized to BTE shocks received 100, 150, 200, and 250 J, as recommended by the manufacturers. In total, 69 patients (51%) received PB shocks and 65 patients (49%) BTE shocks. Successful cardioversion, defined as sinus rhythm 4 hours after cardioversion, was achieved in 43 patients (62%) using PB shocks and in 56 patients (86%) using BTE shocks; ratio 1.4 (95% CI 1.1–1.7) (P=0.002). There was no difference in safety (ie, myocardial injury judged by changes in high‐sensitive troponin I levels; ratio 1.1) (95% CI 1.0–1.3), P=0.15. The study was terminated prematurely because of an adverse event.ConclusionsCardioversion using a BTE waveform was more effective when compared with a PB waveform. There was no difference in safety between the 2 waveforms, as judged by changes in troponin I levels.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02317029.

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Section: Introductionmentioning

confidence: 99%

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Schmidt

Lauridsen

Adelborg

et al. 2017

JAHA

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“…At the initiation of the study (spring 2000) biphasic transthoracic cardioverters were not available in Denmark. However, it should be noted that only one of the three studies comparing monophasic and biphasic waveforms in atrial fibrillation demonstrated a superior cumulated efficacy of biphasic waveforms [19, 20, 21]. Furthermore, none of the studies used repeated shocks of the maximum of 360 J (monophasic) which in our study increased the cumulated efficacy from 48 to 67%.…”

Section: Discussionmentioning

confidence: 52%

“…Since our reference method consisted of high-energy TCV using monophasic pulses, it could be stated that ICV was not compared to the most efficacious method of transthoracic cardioversion. TCV with biphasic waveforms has shown equal or superior efficacy compared to monophasic waveforms in re-establishing sinus rhythm with the use of lower energy [19, 20, 21]. At the initiation of the study (spring 2000) biphasic transthoracic cardioverters were not available in Denmark.…”

Section: Discussionmentioning

confidence: 99%

Intracardiac Low-Energy versus Transthoracic High-Energy Direct-Current Cardioversion of Atrial Fibrillation: A Randomised Comparison

Friberg

Gadsbøll²

2003

Cardiology

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Of 54 patients with long-standing atrial fibrillation (mean duration 8.3 months), 27 patients were randomised to transvenous low-energy intracardiac biphasic direct-current (DC) cardioversion (ICV) using a single-lead balloon-tipped catheter, and 27 patents were randomised to conventional high-energy transthoracic monophasic DC cardioversion (TCV). ICV was performed with increasing energy levels (7.5–10–12.5–15 J) during mild sedation. TCV was performed with 200–360–360 J during general anaesthesia. Cardioversion to sinus rhythm occurred in 93% (25/27) following ICV and in 67% (18/27) following TCV (p = 0.04). Due to the higher cardioversion rate following ICV, more patients were in sinus rhythm during 180 days of follow-up (log rank test, p = 0.04). Low-energy intracardiac cardioversion represents a highly efficacious alternative to high-energy transthoracic cardioversion.

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“…The underlying mechanism of biphasic shock waveforms was explored in experimental studies [16] and its efficacy has been demonstrated in patients with ventricular fibrillation [9,10,11] as well as atrial fibrillation [3, 12, 17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Biphasic versus Monophasic Shock for External Cardioversion of Atrial Flutter

Mortensen¹,

Risius²,

Schwemer³

et al. 2008

Cardiology

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Background: External cardioversion is effective to terminate persistent atrial flutter. Biphasic shocks have been shown to be superior to monophasic shocks for ventricular defibrillation and atrial fibrillation cardioversion. The purpose of this trial was to compare the efficacy of rectilinear biphasic versus standard damped sine wave monophasic shocks in symptomatic patients with typical atrial flutter. Methods: 135 consecutive patients were screened, 95 (70 males, mean age 62 ± 13 years) were included. Patients were randomly assigned to a monophasic or biphasic cardioversion protocol. Forty-seven patients randomized to the monophasic protocol received sequential shocks of 100, 150, 200, 300 and 360 J. Forty-eight patients with the biphasic protocol received 50, 75, 100, 150 or 200 J. Results: First-shock efficacy with 50-Joule, biphasic shocks (23/48 patients, 48%) was significantly greater than with the 100-Joule, monophasic waveform (13/47 patients, 28%, p = 0.04). The cumulative second-shock efficacy with the 50- and 75-Joule, biphasic waveform (39/48 patients, 81%) was significantly greater than with the 100- and 150-Joule, monophasic waveform (25/47 patients, 53%, p < 0.05). The cumulative efficacy for the higher energy levels showed naturally no significant difference between the two groups. The amount of the mean delivered energy was significantly lower in the biphasic group (76 ± 39 J) compared to the monophasic one (177 ± 78 J, p < 0.05). Conclusions: For transthoracic cardioversion of typical atrial flutter, biphasic shocks have greater efficacy and the mean delivered current is lower than for monophasic shocks. Therefore, biphasic cardioversion with lower starting energies should be recommended.

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Biphasic versus monophasic shock waveform for conversion of atrial fibrillation

Abstract: For the cardioversion of AF, a biphasic shock waveform has greater efficacy, requires fewer shocks and lower delivered energy, and results in less dermal injury than a monophasic shock waveform.

Cited by 198 publications

References 15 publications

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Intracardiac Low-Energy versus Transthoracic High-Energy Direct-Current Cardioversion of Atrial Fibrillation: A Randomised Comparison

Biphasic versus Monophasic Shock for External Cardioversion of Atrial Flutter

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