A randomized trial comparing monophasic and biphasic waveform shocks for external cardioversion of atrial fibrillation - 26/08/11
, Paul Dorian, MD b, Fred W Chapman, PhD c, Paul W Schmitt, PhD c, Sharon G O'Grady, MN, RN c, Robert G Walker cAbstract |
Background |
We compared efficacy of and pain felt after biphasic truncated exponential (BTE) and monophasic damped sine (MDS) shocks in patients undergoing external cardioversion of atrial fibrillation (AF).
Methods |
Patients with AF were randomized to BTE or MDS waveform cardioversion. Successive shocks were delivered at 70, 100, 200, and 360 J until successful cardioversion, with one 360 J attempt of the alternate waveform when all 4 shocks failed. Success was determined by blinded over-read of electrocardiograms. Peak current was calculated from energy and impedance. Patients rated their pain at 1 and 24 hours after cardioversion.
Results |
Fourteen of 37 (38%) patients treated with MDS and 34 of 35 (97%) treated with BTE shocks were cardioverted at ≤200 J (P < .0001). Success rates of MDS versus BTE shocks were 5.4% versus 60% for 70 J, 19% versus 80% for ≤100 J, and 86% versus 97% for ≤360 J. BTE shocks cardioverted with less peak current (14.0 ± 4.3 vs 39.5 ± 11.2 A, P < .0001), less energy (97 ± 47 vs 278 ± 120 J, P < .0001), and less cumulative energy (146 ± 116 vs 546 ± 265 J, P < .0001). Patients felt less pain after BTE than MDS shocks at 1 hour (P < .0001) and 24 hours (P < .0001) after cardioversion.
Conclusion |
This BTE waveform is superior to the MDS waveform for cardioversion of AF, requiring much less energy and current, and causing less postprocedural pain.
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 | Supported by a grant from Medtronic-Physio Control, Redmond, Wash, which also supplied the defibrillators used in the study. |
Vol 147 - N° 5
P. e1-e7 - Maggio 2004 Ritorno al numero
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