Biphasic versus Monophasic Cardioversion in Shock‐Resistant Atrial Fibrillation:

Abstract

An ascending sequence of 150-, 200-, and 360-J transthoracic biphasic cardioversion shocks are successful more often than a single 360-J monophasic shock. Thus, biphasic shocks should be the recommended configuration of choice for all cardioversions.

Modulation of Cardiac Autonomic Nervous Activity Early after Cardioversion of Atrial Fibrillation by Biphasic Waveform

“…It is noteworthy that there were no significant differences in HRV indices between the high‐ and low‐energy subgroups in the group treated with Mo waveforms. In clinical practice, Bi CV remains successful even after increasing amounts of unsuccessful Mo energy delivery 15 . Our results may in part explain these clinical observations.…”

“…In clinical practice, Bi CV remains successful even after increasing amounts of unsuccessful Mo energy delivery. 15 Our results may in part ex-plain these clinical observations. On the one hand, Mo CV might cause electrical instability independently of the amount of energy delivered.…”

Part 6: Defibrillation

“…Twenty-two studies have compared specific cardioversion strategies (eg, monophasic versus biphasic defibrillators and different energy levels) administered by cardiologists in the hospital setting to patients with atrial fibrillation (both acute and chronic) (LOE 1 14,17,26,27,31,[102][103][104][105][106][107][108][109][110][111][112][113][114][115] ; LOE 2 116,117 ). Most of these studies documented that biphasic shocks were more effective than monophasic shocks for cardioversion.…”

Effectiveness of dual external direct current cardioversion for initial cardioversion in atrial fibrillation

“…Previous studies have shown that longer duration of AF and presence of cardiomyopathy or pulmonary disease at baseline reduce the success rate of cardioversion for AF. In addition, procedural characteristics such as position and size of electrodes, transthoracic impedance, and monophasic versus biphasic shocks also influence the success rate of cardioversion. In a study of 24 patients undergoing dual‐DCCV, Bjerregaard et al noted no correlation between body surface area and need for dual‐DCCV for treatment for AF.…”