Porcine defibrillation thresholds with chopped biphasic truncated exponential waveforms

Sullivan, Joseph; Melnick, Sharon B.; Chapman, Fred W.; Walcott, Gregory P.

doi:10.1016/j.resuscitation.2007.01.014

Cited by 12 publications

(7 citation statements)

References 18 publications

(2 reference statements)

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“…19,20 The studies found that the same energy levels were needed to terminate ventricular fibrillation using PB shocks compared to a rectilinear biphasic waveform, 19 and more energy when compared to a BTE waveform. 20 These findings are consistent with our study, where more energy was required to cardiovert when using PB shocks compared with BTE shocks. Importantly, the success rate of BTE shocks in our study (89% 1-minute postcardioversion and 86% at discharge) was in accordance with other studies.…”

Section: Discussionmentioning

confidence: 99%

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Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Schmidt

Lauridsen

Adelborg

et al. 2017

JAHA

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BackgroundSeveral different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB shocks with biphasic truncated exponential (BTE) shocks in patients undergoing cardioversion of atrial fibrillation or ‐flutter.Methods and ResultsThis prospective, randomized study included patients admitted for elective direct current cardioversion. Patients were randomized to receive cardioversion using either PB or BTE shocks. We used escalating shocks until sinus rhythm was obtained or to a maximum of 4 shocks. Patients randomized to PB shocks received 90, 120, 150, and 200 J and patients randomized to BTE shocks received 100, 150, 200, and 250 J, as recommended by the manufacturers. In total, 69 patients (51%) received PB shocks and 65 patients (49%) BTE shocks. Successful cardioversion, defined as sinus rhythm 4 hours after cardioversion, was achieved in 43 patients (62%) using PB shocks and in 56 patients (86%) using BTE shocks; ratio 1.4 (95% CI 1.1–1.7) (P=0.002). There was no difference in safety (ie, myocardial injury judged by changes in high‐sensitive troponin I levels; ratio 1.1) (95% CI 1.0–1.3), P=0.15. The study was terminated prematurely because of an adverse event.ConclusionsCardioversion using a BTE waveform was more effective when compared with a PB waveform. There was no difference in safety between the 2 waveforms, as judged by changes in troponin I levels.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02317029.

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Section: Discussionmentioning

confidence: 99%

“…Different versions of PB waveforms have been evaluated in animal studies using ventricular fibrillation pig models . The studies found that the same energy levels were needed to terminate ventricular fibrillation using PB shocks compared to a rectilinear biphasic waveform, and more energy when compared to a BTE waveform .…”

Section: Discussionmentioning

confidence: 99%

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Schmidt

Lauridsen

Adelborg

et al. 2017

JAHA

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“…Psychological effects on patients play a nonnegligible role (9), and despite long-term survival benefits, patients suffering from arrhythmias which are not immediately life-threatening do not tolerate ICD therapy (10). Biphasic (11), multiphasic (12), and truncated exponential (13) shock waveforms defibrillate at a lower threshold, but still too high for painless defibrillation.…”

Section: Introductionmentioning

confidence: 99%

Low Energy Defibrillation in Human Cardiac Tissue: A Simulation Study

Morgan

Plank

Biktasheva

et al. 2009

Biophysical Journal

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We aim to assess the effectiveness of feedback-controlled resonant drift pacing as a method for low energy defibrillation. Antitachycardia pacing is the only low energy defibrillation approach to have gained clinical significance, but it is still suboptimal. Low energy defibrillation would avoid adverse side effects associated with high voltage shocks and allow the application of implantable cardioverter defibrillator (ICD) therapy, in cases where such therapy is not tolerated today. We present results of computer simulations of a bidomain model of cardiac tissue with human atrial ionic kinetics. Reentry was initiated and low energy shocks were applied with the same period as the reentry, using feedback to maintain resonance. We demonstrate that such stimulation can move the core of reentrant patterns, in the direction that depends on the location of the electrodes and the time delay in the feedback. Termination of reentry is achieved with shock strength one-order-of-magnitude weaker than in conventional single-shock defibrillation. We conclude that resonant drift pacing can terminate reentry at a fraction of the shock strength currently used for defibrillation and can potentially work where antitachycardia pacing fails, due to the feedback mechanisms. Success depends on a number of details that these numerical simulations have uncovered.

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“…This study reports higher defibrillation efficacy than similar studies 28 , 29 possibly due to short VF duration. High levels (90–100%) of shock success have been reported after 15-seconds 30 and 30-seconds 31 post-VF-induction. At longer durations (2–7 minutes), shock success reduces despite a high instance of shockable rhythms.…”

Section: Discussionmentioning

confidence: 99%

Pediatric defibrillation shocks alone do not cause heart damage in a porcine model

McCartney¹,

Harvey²,

Kernaghan³

et al. 2022

Resuscitation Plus

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Porcine defibrillation thresholds with chopped biphasic truncated exponential waveforms

Cited by 12 publications

References 18 publications

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Low Energy Defibrillation in Human Cardiac Tissue: A Simulation Study

Pediatric defibrillation shocks alone do not cause heart damage in a porcine model

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