(Circulation. 1997;95:1487-1496.)
© 1997 American Heart Association, Inc.
Articles |
Internal Atrial Defibrillation in Humans
Improved Efficacy of Biphasic Waveforms and the Importance of Phase Duration
From the Department of Medicine, Duke University Medical Center, Durham, NC.
Correspondence to Randolph A.S. Cooper, MD, Room B-140, Volker Hall, 1670 University Blvd, University of Alabama at Birmingham, Birmingham, AL 35294-0019. E-mail rac{at}crml.uab.edu.
Background The optimal waveform for internal atrial defibrillation (IAD) in humans is unknown. This study tested the effect of waveform duration and phase duration on the efficacy of biphasic waveforms for IAD.
Methods and Results Electrodes were positioned in the right atrial appendage and coronary sinus in 13 patients. In part 1, the atrial defibrillation thresholds (ADFTs) for 5 monophasic waveforms (2, 4, 6, 10, and 20 ms) and 5 symmetrical biphasic waveforms (1/1, 2/2, 3/3, 5/5, and 10/10 ms) were compared in 6 patients. In part 2, the ADFTs for two asymmetrical biphasic waveforms (7.5/2.5 and 2.5/7.5 ms) were compared with those for a symmetrical biphasic waveform (5/5 ms) and a monophasic waveform (10 ms) in 7 patients. In part 1, biphasics with total durations of 4 to 20 ms had significantly lower ADFTs than monophasic waveforms of the same total duration. For a total duration of 2 ms, there was no significant difference in ADFTs between the biphasic and the monophasic waveforms. There was no difference between symmetrical biphasic waveforms of 4 to 20 ms. In part 2, the 7.5/2.5 ms asymmetrical biphasic had significantly lower ADFTs than the three other waveforms tested. Both the 7.5/2.5 ms asymmetrical and the 5/5 ms symmetrical biphasic waveform had significantly lower ADFTs than the 2.5/7.5 ms asymmetrical biphasic and the 10 ms monophasic waveforms.
Conclusions For IAD in humans, biphasic waveforms were more efficacious than monophasic waveforms. This improved efficacy is related to the total duration of the biphasic waveform and each individual phase duration of the biphasic waveform.
Key Words: defibrillation • atrium • arrhythmia
This article has been cited by other articles:
 |
|
 |
|
  S. J. Walsh, G. Manoharan, O. J. Escalona, J. Santos, N. Evans, J. McC. Anderson, M. Stevenson, J. D. Allen, and A.A. J. Adgey Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation. Europace, October 1, 2006; 8(10): 873 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Walsh, D. McCarty, A. J.J. McClelland, C. G. Owens, T. G. Trouton, M. T. Harbinson, S. O'Mullan, A. McAllister, B. M. McClements, M. Stevenson, et al. Impedance compensated biphasic waveforms for transthoracic cardioversion of atrial fibrillation: a multi-centre comparison of antero-apical and antero-posterior pad positions Eur. Heart J., July 1, 2005; 26(13): 1298 - 1302. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Manoharan, N. Evans, D. Allen, J. Anderson, and J. Adgey Comparing the Efficacy and Safety of a Novel Monophasic Waveform Delivered by the Passive Implantable Atrial Defibrillator With Biphasic Waveforms in Cardioversion of Atrial Fibrillation Circulation, April 6, 2004; 109(13): 1686 - 1692. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Q. Villani, M. F. Piepoli, and A. Capucci Reproducibility of internal atrial defibrillation threshold in paroxysmal and persistent atrial fibrillation Europace, January 1, 2004; 6(4): 267 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.C. Geller, S. Reek, C. Timmermans, T. Kayser, H.-F. Tse, C. Wolpert, W. Jung, A.J. Camm, C.-P. Lau, H. J.J. Wellens, et al. Treatment of atrial fibrillation with an implantable atrial defibrillator -- long term results Eur. Heart J., December 1, 2003; 24(23): 2083 - 2089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Manoharan, N. Evans, B. Kidwai, D. Allen, J. Anderson, and J. Adgey Novel Passive Implantable Atrial Defibrillator Using Transcutaneous Radiofrequency Energy Transmission Successfully Cardioverts Atrial Fibrillation Circulation, September 16, 2003; 108(11): 1382 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Lehmann, J. Horcher, K. Dennig, A. Plewan, K. Ulm, and E. Alt Atrial Mechanical Performance After Internal and External Cardioversion of Atrial Fibrillation : An Echocardiographic Study Chest, January 1, 2002; 121(1): 13 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Ammer, G.u. Lehmann, A. Plewan, K. Puetter, and E. Alt Marked reduction in atrial defibrillation thresholds with repeated internal cardioversion J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1569 - 1576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cooklin, M. R. Olsovsky, R. G. Brockman, S. R. Shorofsky, and M. R. Gold Atrial defibrillation with a transvenous lead: A randomized comparison of active can shocking pathways J. Am. Coll. Cardiol., August 1, 1999; 34(2): 358 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Timmermans, L.-M. Rodriguez, G. M. Ayers, H. Lambert, J. L. R. M. Smeets, J. W. S. Vlaeyen, A. Albert, and H. J. J. Wellens Effect of Butorphanol Tartrate on Shock-Related Discomfort During Internal Atrial Defibrillation Circulation, April 13, 1999; 99(14): 1837 - 1842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. S. Cooper, V. J. Plumb, A. E. Epstein, G. N. Kay, and R. E. Ideker Marked Reduction in Internal Atrial Defibrillation Thresholds With Dual-Current Pathways and Sequential Shocks in Humans Circulation, June 30, 1998; 97(25): 2527 - 2535. [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. A. Gray and J. Jalife Effects of Atrial Defibrillation Shocks on the Ventricles in Isolated Sheep Hearts Circulation, April 28, 1998; 97(16): 1613 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. S. Cooper, W. M. Smith, and R. E. Ideker Internal Cardioversion of Atrial Fibrillation : Marked Reduction in Defibrillation Threshold With Dual Current Pathways Circulation, October 21, 1997; 96(8): 2693 - 2700. [Abstract] [Full Text]
|
|