An Ascending Ramp Biphasic Waveform Has a Lower Defibrillation Threshold and Releases Less Troponin I Than a Truncated Exponential Biphasic Waveform
Background—We tested the hypothesis that the shape of the shock waveform affects not only the defibrillation threshold (DFT), but also the amount of cardiac damage.
Methods and Results—DFTs were determined for 11 waveforms: 3 ascending ramp, 3 descending ramp, and 3 rectilinear first phase biphasic waveforms, a Gurvich waveform, and a truncated exponential biphasic waveform in 6 pigs with electrodes in the RV apex and SVC. The ascending, descending and rectilinear waveforms had 4, 8 and 16 ms 1st phases and a 3.5 ms 2nd rectilinear phase half the voltage of the 1st phase. The exponential biphasic waveform had a 60% 1stt phase and a 50% 2nd phase tilt. In a second study, we attempted to defibrillate after 10 s of VF with a single ≈ 30 J shock (6 pigs successfully defibrillated with 8 ms ascending, 8 ms rectilinear wave and truncated exponential biphasic waveforms). Troponin I blood levels were determined before and 2 to 10 hrs after the shock.The lowest energy DFT was for the 8 ms ascending ramp (14.6±7.3 SD J), which was significantly less than for the truncated exponential (19.6±6.3 J). Six hours postshock, troponin I in ng/ml was significantly less for the ascending ramp (0.80±0.54) than for the truncated exponential (1.92±0.47) or the rectilinear waveform (1.17 ±0.45).
Conclusions—The ascending ramp has a significantly lower DFT, and at ≈ 30 J causes 58% less troponin I release than the truncated exponential biphasic shock. Therefore, the shock waveform affects both the DFT and the amount of cardiac damage.
- Received April 9, 2012.
- Accepted July 20, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited