BACKGROUND: Transthoracic cardioversion fails to restore sinus rhythm in 6% to 33% of patients with atrial fibrillation. This study sought to determine the relative efficacy of biphasic waveforms compared with monophasic waveforms in the treatment of atrial arrhythmias. METHODS: A total of 912 patients underwent 1022 transthoracic cardioversions between May 2000 and December 2001. A monophasic damped sine waveform was used in the first 304 cases, and a rectilinear biphasic defibrillator was used in the next 718 cases. RESULTS: Use of a biphasic waveform was associated with 94% success in conversion to sinus rhythm compared with 84% with a monophasic waveform (P < .001). The cumulative energy required to restore sinus rhythm was lower with biphasic shocks in both atrial fibrillation and atrial flutter groups (554 +/- 413 J for monophasic vs 199 +/- 216 J for biphasic shocks in the atrial fibrillation group, P < .001; 251 +/- 302 J vs 108 +/- 184 J, respectively, in the atrial flutter group, P < .001). In a multivariate analysis, use of a biphasic shock was associated with a 3.9-fold increase in success of cardioversion. CONCLUSION: When used to cardiovert atrial arrhythmias, the rectilinear biphasic waveform was associated with higher success rates and lower cumulative energies than the monophasic damped sine waveform.
BACKGROUND: Transthoracic cardioversion fails to restore sinus rhythm in 6% to 33% of patients with atrial fibrillation. This study sought to determine the relative efficacy of biphasic waveforms compared with monophasic waveforms in the treatment of atrial arrhythmias. METHODS: A total of 912 patients underwent 1022 transthoracic cardioversions between May 2000 and December 2001. A monophasic damped sine waveform was used in the first 304 cases, and a rectilinear biphasic defibrillator was used in the next 718 cases. RESULTS: Use of a biphasic waveform was associated with 94% success in conversion to sinus rhythm compared with 84% with a monophasic waveform (P < .001). The cumulative energy required to restore sinus rhythm was lower with biphasic shocks in both atrial fibrillation and atrial flutter groups (554 +/- 413 J for monophasic vs 199 +/- 216 J for biphasic shocks in the atrial fibrillation group, P < .001; 251 +/- 302 J vs 108 +/- 184 J, respectively, in the atrial flutter group, P < .001). In a multivariate analysis, use of a biphasic shock was associated with a 3.9-fold increase in success of cardioversion. CONCLUSION: When used to cardiovert atrial arrhythmias, the rectilinear biphasic waveform was associated with higher success rates and lower cumulative energies than the monophasic damped sine waveform.
Authors: Edward A El-Am; Angela Dispenzieri; Rowlens M Melduni; Naser M Ammash; Roger D White; David O Hodge; Peter A Noseworthy; Grace Lin; Sorin V Pislaru; Alexander C Egbe; Martha Grogan; Vuyisile T Nkomo Journal: J Am Coll Cardiol Date: 2019-02-12 Impact factor: 24.094
Authors: Rowlens M Melduni; Bernard J Gersh; Waldemar E Wysokinski; Naser M Ammash; Paul A Friedman; David O Hodge; Krishnaswamy Chandrasekaran; Jae K Oh; Hon-Chi Lee Journal: Am J Cardiol Date: 2018-03-13 Impact factor: 2.778
Authors: Handrean Soran; Moulinath Banerjee; Jamal B Mohamad; Safwaan Adam; Jan Hoong Ho; Shakawan M Ismaeel; Shaishav Dhage; Akheel A Syed; Ibrahem M A Abdulla; Naveed Younis; Rayaz A Malik Journal: Biomed Res Int Date: 2018-03-12 Impact factor: 3.411