TY - JOUR
T1 - Comparative efficacy of monophasic and biphasic waveforms for transthoracic cardioversion of atrial fibrillation and atrial flutter
AU - Gurevitz, Osnat T.
AU - Ammash, Naser M.
AU - Malouf, Joseph F.
AU - Chandrasekaran, Krishnaswamy
AU - Rosales, Ana Gabriela
AU - Ballman, Karla V.
AU - Hammill, Stephen C.
AU - White, Roger D.
AU - Gersh, Bernard J.
AU - Friedman, Paul A.
PY - 2005/2
Y1 - 2005/2
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ahj.2004.07.007
DO - 10.1016/j.ahj.2004.07.007
M3 - Article
C2 - 15846271
AN - SCOPUS:20044376073
SN - 0002-8703
VL - 149
SP - 316
EP - 321
JO - American heart journal
JF - American heart journal
IS - 2
ER -