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Biphasic waveform defibrillation using a three-electrode transvenous lead system in humans

M L Marks1, G Johnson, B O Hofer

  • 1Department of Medicine, University of Washington, Seattle 98195.

Journal of Cardiovascular Electrophysiology
|February 1, 1994
PubMed
Summary

Biphasic waveform defibrillation is more effective than monophasic with specific lead systems. This study found biphasic pulses significantly reduce defibrillation threshold voltage and energy requirements.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Biphasic waveform defibrillation efficacy is not universally superior to monophasic.
  • Efficacy can be influenced by the specific lead system employed.

Purpose of the Study:

  • To compare defibrillation efficacy of biphasic versus monophasic waveforms.
  • To evaluate this comparison using a specific lead system: right ventricular (RV), chest patch (CP), and superior vena cava (SVC) electrodes.

Main Methods:

  • Prospective, randomized study involving 14 cardiac arrest survivors undergoing defibrillator implantation.
  • Comparison of biphasic and monophasic pulses delivered via RV, SVC, and CP electrodes.
  • Measurement of defibrillation threshold (DFT) voltage and stored energy.

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Main Results:

  • Biphasic DFT voltage (451 +/- 185 V) was significantly lower than monophasic (661 +/- 177 V).
  • Biphasic DFT stored energy (14.1 +/- 12.4 J) was significantly lower than monophasic (28.0 +/- 13.4 J).
  • 71% of patients achieved DFT <= 15 J with biphasic, versus 15% with monophasic.

Conclusions:

  • Biphasic defibrillation with the RV, SVC, CP transvenous electrode system is substantially more efficient.
  • This approach allows more patients to receive transvenous defibrillators with a simple lead system and a 15 J safety margin.