This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Osswald, S. Articles by Garan, H. Search for Related Content PubMed PubMed Citation Articles by Osswald, S. Articles by Garan, H.

Circulation, Vol 90, 2501-2509, Copyright © 1994 by American Heart Association

ARTICLES

Relation between shock-related myocardial injury and defibrillation efficacy of monophasic and biphasic shocks in a canine model

S Osswald, TG Trouton, SS O'Nunain, HB Holden, JN Ruskin and H Garan
Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.

BACKGROUND--Certain biphasic waveforms with specific time ratios of positive and negative components require less energy for successful defibrillation of the fibrillating ventricles than monophasic waveforms. However, if more efficient waveforms were also to be associated with more injurious effects on myocardial function, they might not provide a true biological advantage. This study investigates the relation between defibrillation efficacy and potential toxicity of monophasic and asymmetric, single capacitor, biphasic waveforms with equal durations of positive and negative components. METHODS AND RESULTS--The myocardial lactate extraction rate (LER) was used to measure the injurious effects on myocardial oxidative metabolism of two synchronized 35-J shocks in sinus rhythm. LER, mean arterial pressure (MAP) and, in a subset of experiments, cardiac output (CO) and coronary blood flow (CBF) were measured at baseline, 30 seconds, 60 seconds, 90 seconds, 150 seconds, 300 seconds, and 600 seconds after the shocks. In 12 dogs, three different waveforms (M 10: monophasic 10 milliseconds; BI 10: biphasic 10 milliseconds; BI 20: biphasic 20 milliseconds) were tested as series of two consecutive shocks (60 seconds apart) resulting in a total of 36 sets of data. At baseline, LER was 25 +/- 11%. After monophasic shocks, LER decreased significantly more than after biphasic shocks (LER at 150 seconds: M 10: -6 +/- 31% versus BI 10: 21 +/- 15% versus BI 20: 21 +/- 16%; M 10 versus BI 10 and M 10 versus BI 20, P < .05) and showed also a slower recovery (LER at 300 seconds: M 10: 1 +/- 24% versus BI 10: 20 +/- 11% versus BI 20: 20 +/- 15%; M 10 versus BI 10 and M 10 versus BI 20, P < .05). The maximal decrease in LER was 41 +/- 27% for M 10 compared with 18 +/- 15% for BI 10 and 15 +/- 11% for BI 20 (both, M 10 versus BI 10 and M 10 versus BI 20, P < .05). There was a similar decrease in CO and MAP, with the lowest MAP after monophasic shocks. The maximal decrease in MAP was significantly greater after M 10 compared with BI 20 (-29 +/- 15 mm Hg versus -13 +/- 11 mm Hg, P < .05). The defibrillation threshold was 18.6 +/- 8 J for M 10 compared with 11.5 +/- 4.0 J for BI 10 (P < .05) and 15.0 +/- 6.1 J for BI 20, respectively (P = NS). CONCLUSIONS--Our results suggest that these specific biphasic waveforms are associated with less injurious effects on myocardial oxidative metabolism and hemodynamic performance. Given their higher defibrillation efficacy as well, biphasic waveforms may provide important long-term benefits in patients receiving frequent shocks from implantable cardioverter-defibrillators.

This article has been cited by other articles:

				L. G. Tereshchenko, M. N. Faddis, B. J. Fetics, K. E. Zelik, I. R. Efimov, and R. D. Berger Transient local injury current in right ventricular electrogram after implantable cardioverter-defibrillator shock predicts heart failure progression. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 822 - 828. [Abstract] [Full Text] [PDF]

				C. Cevik, A. Perez-Verdia, and K. Nugent Implantable cardioverter defibrillators and their role in heart failure progression Europace, June 1, 2009; 11(6): 710 - 715. [Abstract] [Full Text] [PDF]

				D. Markenson, L. Pyles, S. Neish, and and the Committee on Pediatric Emergency Medicine Ventricular Fibrillation and the Use of Automated External Defibrillators on Children Pediatrics, November 1, 2007; 120(5): e1368 - e1379. [Abstract] [Full Text] [PDF]

				P Jones and N Lode Ventricular fibrillation and defibrillation Arch. Dis. Child., October 1, 2007; 92(10): 916 - 921. [Abstract] [Full Text] [PDF]

				C. M. Ripplinger, V. I. Krinsky, V. P. Nikolski, and I. R. Efimov Mechanisms of unpinning and termination of ventricular tachycardia Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H184 - H192. [Abstract] [Full Text] [PDF]

				A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]

				V. P. Nikolski and I. R. Efimov Electroporation of the heart Europace, January 1, 2005; 7(s2): S146 - S154. [Abstract] [Full Text] [PDF]

				S.-r. Wann, M. H. Weil, S. Sun, W. Tang, and T. Yu Cariporide for Pharmacologic Defibrillation After Prolonged Cardiac Arrest Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2002; 7(3): 161 - 169. [Abstract] [PDF]

				W. Tang, M. H. Weil, S. Sun, H. P. Povoas, K. Klouche, T. Kamohara, and J. Bisera A Comparison of Biphasic and Monophasic Waveform Defibrillation After Prolonged Ventricular Fibrillation Chest, September 1, 2001; 120(3): 948 - 954. [Abstract] [Full Text] [PDF]

				T. Schneider, P. R. Martens, H. Paschen, M. Kuisma, B. Wolcke, B. E. Gliner, J. K. Russell, W. D. Weaver, L. Bossaert, and D. Chamberlain Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims Circulation, October 10, 2000; 102(15): 1780 - 1787. [Abstract] [Full Text] [PDF]

				J. T. Niemann, D. Burian, D. Garner, and R. J. Lewis Monophasic versus biphasic transthoracic countershock after prolonged ventricular fibrillation in a swine model J. Am. Coll. Cardiol., September 1, 2000; 36(3): 932 - 938. [Abstract] [Full Text] [PDF]

				C. T. Leng, N. A. Paradis, H. Calkins, R. D. Berger, A. C. Lardo, K. C. Rent, and H. R. Halperin Resuscitation After Prolonged Ventricular Fibrillation With Use of Monophasic and Biphasic Waveform Pulses for External Defibrillation Circulation, June 27, 2000; 101(25): 2968 - 2974. [Abstract] [Full Text] [PDF]

				W. Tang, M. H. Weil, S. Sun, H. Yamaguchi, H. P. Povoas, A. M. Pernat, and J. Bisera The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function J. Am. Coll. Cardiol., September 1, 1999; 34(3): 815 - 822. [Abstract] [Full Text] [PDF]

				L. A. Pires, M. H. Lehmann, R. T. Steinman, J. J. Baga, C. D. Schuger, and Participating Investigators Sudden death in implantable cardioverter-defibrillator recipients: clinical context, arrhythmic events and device responses J. Am. Coll. Cardiol., January 1, 1999; 33(1): 24 - 32. [Abstract] [Full Text] [PDF]

				A A J Adgey and P W Johnston Approaches to modern management of cardiac arrest Heart, October 1, 1998; 80(4): 397 - 401. [Full Text]

				J. Xie, M. H. Weil, S. Sun, W. Tang, Y. Sato, X. Jin, and J. Bisera High-Energy Defibrillation Increases the Severity of Postresuscitation Myocardial Dysfunction Circulation, July 15, 1997; 96(2): 683 - 688. [Abstract] [Full Text]