Circulation, Vol 82, 2128-2141, Copyright © 1990 by American Heart Association
SA Feeser, AS Tang, KM Kavanagh, DL Rollins, WM Smith, PD Wolf and RE Ideker
Certain biphasic waveforms require less energy to defibrillate than do
monophasic pulses of equal duration, although the mechanisms of this
increased effectiveness remain unclear. This study used strength- duration
and percent success curves for defibrillation with monophasic and biphasic
truncated exponential waveforms to explore these mechanisms. In part 1,
defibrillation thresholds were determined for both high- and low-tilt
waveforms. The monophasic pulses tested ranged in duration from 1.0 to 20.0
msec, and the biphasic waveforms had first phases of either 3.5 or 7.0 msec
and second phases ranging from 1.0 to 20.0 msec. In part 2, defibrillation
percent success curves were constructed for 6.0 msec/6.0 msec biphasic
waveforms with a constant phase-one amplitude and with phase-two amplitudes
of approximately 21%, 62%, 94%, and 141% of phase one. This study shows
that if the first phase of a biphasic waveform is held constant and the
second phase is increased in either duration or amplitude, defibrillation
efficacy first improves, then declines, and then again improves. For pulse
durations of at least 14 msec, the second-phase defibrillation threshold
voltage of a high-tilt biphasic waveform is higher than that of a
monophasic pulse equal in duration to the biphasic second phase (p less
than 0.05), indicating that the previously proposed hypothesis of
stimulation by the second phase is not the sole mechanism of biphasic
defibrillation. These facts indicate the importance of the degree of tilt
for the defibrillation efficacy of biphasic waveforms and suggest at least
two mechanisms exist for defibrillation with these waveforms, one that is
more effective for smaller second phases and another that becomes more
effective as the second phase is increased.
ARTICLES
Strength-duration and probability of success curves for defibrillation with biphasic waveforms
Department of Medicine, Duke University Medical Center, Durham, N.C. 27710.
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