This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gliner, B. E. Articles by Bardy, G. H. Search for Related Content PubMed PubMed Citation Articles by Gliner, B. E. Articles by Bardy, G. H.

(Circulation. 1995;92:1634-1643.)
© 1995 American Heart Association, Inc.

Articles

Transthoracic Defibrillation of Swine With Monophasic and Biphasic Waveforms

Bradford E. Gliner, MSBME; Thomas E. Lyster, MSEE; Stephen M. Dillion, PhD; Gust H. Bardy, MD

From the Department of Medicine, University of Washington, Seattle, and the Philadelphia Heart Institute (S.M.D.), Presbyterian Medical Center, Philadelphia, Pa.

Correspondence to Bradford E. Gliner, c/o Gust H. Bardy, MD, Electrophysiology Section, Mail Stop RG-22, University Hospital, Seattle, WA 98195.

Background Biphasic waveforms have had a favorable impact on internal defibrillation but have seen minimal use in transthoracic defibrillation systems. The purpose of this study was to compare monophasic and biphasic waveforms for transthoracic defibrillation in swine.

Methods and Results Three interrelated studies were performed in 19 swine to establish the relative transthoracic defibrillation efficacy of biphasic shock waveforms. In study 1, we measured voltage (V₅₀) and energy (E₅₀) strength-duration curves for monophasic and biphasic truncated exponential waveforms. We then independently examined the effects of phase duration and tilt on biphasic waveform defibrillation with a total waveform duration from study 1 that provided the minimum V₅₀ (study 2) and the minimum E₅₀ (study 3). At each pulse duration tested in study 1, biphasic waveforms defibrillated with significantly less voltage and energy than monophasic waveforms. At a duration of 12 ms, there was a voltage minimum for biphasic waveform defibrillation. At this duration, V₅₀ was 1378±505 V for the biphasic waveform compared with 2185±361 V for the monophasic waveform, P=.01. For both monophasic and biphasic waveforms, E₅₀ increased with pulse duration. With a total pulse duration of 12 ms, E₅₀ was 169±101 J for the biphasic waveform compared with 414±114 J for the monophasic waveform, P=.003. In study 2, optimization of phase duration and total tilt reduced the defibrillation requirements of the 12-ms "minimum voltage" biphasic waveform to 1284±187 V and 129±36 J. In study 3, the 8-ms "minimum energy" biphasic waveform had an E₅₀ of 115±35 J that was 11% less than the 12-ms biphasic waveform, P=.11; however, voltage requirements of 1476±239 V were 15% higher, P=.005.

Conclusions This study demonstrates the superiority of truncated biphasic waveforms over truncated monophasic waveforms for transthoracic defibrillation of swine. Biphasic waveforms should prove as advantageous at reducing voltage and energy requirements for transthoracic defibrillation as they have for internal defibrillation.

Key Words: fibrillation • defibrillation • waves • death, sudden

This article has been cited by other articles:

				P Jones and N Lode Ventricular fibrillation and defibrillation Arch. Dis. Child., October 1, 2007; 92(10): 916 - 921. [Abstract] [Full Text] [PDF]

				Part 3: Defibrillation Circulation, November 29, 2005; 112(22_suppl): III-17 - III-24. [Full Text] [PDF]

				W. Tang, M. H. Weil, S. Sun, D. Jorgenson, C. Morgan, K. Klouche, and D. Snyder The effects of biphasic waveform design on post-resuscitation myocardial function J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1228 - 1235. [Abstract] [Full Text] [PDF]

				Y. Zhang, R. S. Ramabadran, K. A. Boddicker, I. Bawaney, L. R. Davies, M. B. Zimmerman, S. Wuthrich, J. L. Jones, and R. E. Kerber Triphasic waveforms are superior to biphasic waveforms for transthoracic defibrillation: Experimental studies J. Am. Coll. Cardiol., August 6, 2003; 42(3): 568 - 575. [Abstract] [Full Text] [PDF]

				T. Schneider, P. R. Martens, H. Paschen, M. Kuisma, B. Wolcke, B. E. Gliner, J. K. Russell, W. D. Weaver, L. Bossaert, and D. Chamberlain Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims Circulation, October 10, 2000; 102(15): 1780 - 1787. [Abstract] [Full Text] [PDF]

				J. T. Niemann, D. Burian, D. Garner, and R. J. Lewis Monophasic versus biphasic transthoracic countershock after prolonged ventricular fibrillation in a swine model J. Am. Coll. Cardiol., September 1, 2000; 36(3): 932 - 938. [Abstract] [Full Text] [PDF]

				W. Tang, M. H. Weil, S. Sun, H. Yamaguchi, H. P. Povoas, A. M. Pernat, and J. Bisera The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function J. Am. Coll. Cardiol., September 1, 1999; 34(3): 815 - 822. [Abstract] [Full Text] [PDF]

				Y. Yamanouchi, J. E. Brewer, K. F. Olson, K. A. Mowrey, T. N. Mazgalev, B. L. Wilkoff, and P. J. Tchou Fully Discharging Phases : A New Approach to Biphasic Waveforms for External Defibrillation Circulation, August 24, 1999; 100(8): 826 - 831. [Abstract] [Full Text] [PDF]

				L. A. Pagan-Carlo, J. J. Allan, K. T. Spencer, C. L. Birkett, R. Myers, and R. E. Kerber Encircling overlapping multipulse shock waveforms for transthoracic defibrillation J. Am. Coll. Cardiol., December 1, 1998; 32(7): 2065 - 2071. [Abstract] [Full Text] [PDF]

				Y. Yamanouchi, J. E. Brewer, K. A. Mowrey, A. M. Donohoo, B. L. Wilkoff, and P. J. Tchou Optimal Small-Capacitor Biphasic Waveform for External Defibrillation : Influence of Phase-1 Tilt and Phase-2 Voltage Circulation, December 1, 1998; 98(22): 2487 - 2493. [Abstract] [Full Text] [PDF]

				G. P. Walcott, S. B. Melnick, F. W. Chapman, J. L. Jones, W. M. Smith, and R. E. Ideker Relative Efficacy of Monophasic and Biphasic Waveforms for Transthoracic Defibrillation After Short and Long Durations of Ventricular Fibrillation Circulation, November 17, 1998; 98(20): 2210 - 2215. [Abstract] [Full Text] [PDF]

				P. Schauerte, F. A. Schondube, M. Grossmann, H. Dorge, F. Stein, B. Dohmen, A. Moumen, K. Erena, B. J. Messmer, P. Hanrath, et al. Influence of Phase Duration of Biphasic Waveforms on Defibrillation Energy Requirements With a 70-µF Capacitance Circulation, May 26, 1998; 97(20): 2073 - 2078. [Abstract] [Full Text] [PDF]

				R. O. Cummins, M. F. Hazinski, R. E. Kerber, P. Kudenchuk, L. Becker, G. Nichol, B. Malanga, T. P. Aufderheide, E. M. Stapleton, K. Kern, et al. Low-Energy Biphasic Waveform Defibrillation: Evidence-Based Review Applied to Emergency Cardiovascular Care Guidelines : A Statement for Healthcare Professionals From the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation Circulation, April 28, 1998; 97(16): 1654 - 1667. [Full Text] [PDF]

				G. H. Bardy, F. E. Marchlinski, A. D. Sharma, S. J. Worley, R. M. Luceri, R. Yee, B. D. Halperin, C. L. Fellows, T. S. Ahern, D. A. Chilson, et al. Multicenter Comparison of Truncated Biphasic Shocks and Standard Damped Sine Wave Monophasic Shocks for Transthoracic Ventricular Defibrillation Circulation, November 15, 1996; 94(10): 2507 - 2514. [Abstract] [Full Text]