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Reduced cardioversion thresholds for atrial fibrillation and flutter using the rectilinear biphasic waveform
Mark J Niebauer1, Mina K Chung, James E Brewer
1Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-2265, USA. mniebaue@unmc.edu
Summary
Rectilinear biphasic (RLB) waveform cardioversion for atrial fibrillation (AF) requires significantly lower energy than monophasic damped sine (MDS). RLB is also more effective for atrial flutter (FL) than AF.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Rectilinear biphasic (RLB) waveform shows superior efficacy for atrial fibrillation (AF) cardioversion compared to monophasic damped sine (MDS).
- Limited data exists on RLB waveform efficacy at lower energy levels.
Purpose of the Study:
- Determine cardioversion thresholds for AF and flutter (FL) using the RLB waveform.
- Compare RLB waveform cardioversion thresholds to the conventional MDS waveform.
Main Methods:
- Transthoracic cardioversion performed on patients with persistent AF and FL.
- Step-up cardioversion thresholds determined for AF (180 RLB, 38 MDS patients) and FL (39 RLB patients).
- Energy settings ranged from 5 J to 200 J for RLB and 50 J to 360 J for MDS.
Main Results:
- Average AF cardioversion threshold: 70.6 J (RLB) vs. 193.4 J (MDS) (p<0.001).
- Average FL cardioversion threshold: 33.2 J (RLB) (p<0.001 vs. AF with RLB).
Conclusions:
- RLB waveform significantly lowers transthoracic AF cardioversion energy requirements compared to MDS.
- RLB waveform demonstrates a significantly lower cardioversion threshold for FL compared to AF.