A pilot study of a low-tilt biphasic waveform for transvenous cardioversion of atrial fibrillation: Improved efficacy compared with conventional capacitor-based waveforms in patients

BM Glover, CJ McCann, G Manoharan, SJ Walsh, MJ Moore, JD Allen, OJ Escalona, JMCC Anderson, TG Trouton, M Stevenson, MJ Roberts, JAA Adgey

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The optimal waveform tilt for defibrillation is not known. Most modern defibrillators used for the cardioversion of atrial fibrillation (AF) employ high-tilt, capacitor-based biphasic waveforms. Methods: We have developed a low-tilt biphasic waveform for defibrillation. This low-tilt waveform was compared with a conventional waveform of equivalent duration and voltage in patients with AF. Patients with persistent AF or AF induced during a routine electrophysiology study (EPS) were randomized to receive either the low-tilt waveform or a conventional waveform. Defibrillation electrodes were positioned in the right atrial appendage and distal coronary sinus. Phase 1 peak voltage was increased in a stepwise progression from 50 V to 300V Shock success was defined as return of sinus rhythm for >= 30 seconds. Results: The low-tilt waveform produced successful termination of persistent AF at a mean voltage of 223 V (8.2 J) versus 270 V (6.7 J) with the conventional waveform (P = 0.002 for voltage, P = ns for energy). In patients with induced AF the mean voltage for the low-tilt waveform was 91 V (1.6 J) and for the conventional waveform was 158 V (2.0 J) (P = 0.005 for voltage, P = ns for energy). The waveform was much more successful at very low voltages (less than or equal to 100 V) compared with the conventional waveform (Novel: 82% vs Conventional 22%, P = 0.008). Conclusion: The low-tilt biphasic waveform was more successful for the internal cardioversion of both persistent and induced AF in patients (in terms of leading edge voltage).
LanguageEnglish
Pages1020-1024
JournalPace-Pacing and Clinical Electrophysiology
Volume31
Issue number8
Publication statusPublished - Aug 2008

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Electric Countershock
Atrial Fibrillation
Atrial Appendage
Defibrillators
Coronary Sinus
Electrophysiology
Shock
Electrodes

Keywords

  • atrial fibrillation
  • direct current cardioversion

Cite this

Glover, BM ; McCann, CJ ; Manoharan, G ; Walsh, SJ ; Moore, MJ ; Allen, JD ; Escalona, OJ ; Anderson, JMCC ; Trouton, TG ; Stevenson, M ; Roberts, MJ ; Adgey, JAA. / A pilot study of a low-tilt biphasic waveform for transvenous cardioversion of atrial fibrillation: Improved efficacy compared with conventional capacitor-based waveforms in patients. In: Pace-Pacing and Clinical Electrophysiology. 2008 ; Vol. 31, No. 8. pp. 1020-1024.
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abstract = "Background: The optimal waveform tilt for defibrillation is not known. Most modern defibrillators used for the cardioversion of atrial fibrillation (AF) employ high-tilt, capacitor-based biphasic waveforms. Methods: We have developed a low-tilt biphasic waveform for defibrillation. This low-tilt waveform was compared with a conventional waveform of equivalent duration and voltage in patients with AF. Patients with persistent AF or AF induced during a routine electrophysiology study (EPS) were randomized to receive either the low-tilt waveform or a conventional waveform. Defibrillation electrodes were positioned in the right atrial appendage and distal coronary sinus. Phase 1 peak voltage was increased in a stepwise progression from 50 V to 300V Shock success was defined as return of sinus rhythm for >= 30 seconds. Results: The low-tilt waveform produced successful termination of persistent AF at a mean voltage of 223 V (8.2 J) versus 270 V (6.7 J) with the conventional waveform (P = 0.002 for voltage, P = ns for energy). In patients with induced AF the mean voltage for the low-tilt waveform was 91 V (1.6 J) and for the conventional waveform was 158 V (2.0 J) (P = 0.005 for voltage, P = ns for energy). The waveform was much more successful at very low voltages (less than or equal to 100 V) compared with the conventional waveform (Novel: 82{\%} vs Conventional 22{\%}, P = 0.008). Conclusion: The low-tilt biphasic waveform was more successful for the internal cardioversion of both persistent and induced AF in patients (in terms of leading edge voltage).",
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Glover, BM, McCann, CJ, Manoharan, G, Walsh, SJ, Moore, MJ, Allen, JD, Escalona, OJ, Anderson, JMCC, Trouton, TG, Stevenson, M, Roberts, MJ & Adgey, JAA 2008, 'A pilot study of a low-tilt biphasic waveform for transvenous cardioversion of atrial fibrillation: Improved efficacy compared with conventional capacitor-based waveforms in patients', Pace-Pacing and Clinical Electrophysiology, vol. 31, no. 8, pp. 1020-1024.

A pilot study of a low-tilt biphasic waveform for transvenous cardioversion of atrial fibrillation: Improved efficacy compared with conventional capacitor-based waveforms in patients. / Glover, BM; McCann, CJ; Manoharan, G; Walsh, SJ; Moore, MJ; Allen, JD; Escalona, OJ; Anderson, JMCC; Trouton, TG; Stevenson, M; Roberts, MJ; Adgey, JAA.

In: Pace-Pacing and Clinical Electrophysiology, Vol. 31, No. 8, 08.2008, p. 1020-1024.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A pilot study of a low-tilt biphasic waveform for transvenous cardioversion of atrial fibrillation: Improved efficacy compared with conventional capacitor-based waveforms in patients

AU - Glover, BM

AU - McCann, CJ

AU - Manoharan, G

AU - Walsh, SJ

AU - Moore, MJ

AU - Allen, JD

AU - Escalona, OJ

AU - Anderson, JMCC

AU - Trouton, TG

AU - Stevenson, M

AU - Roberts, MJ

AU - Adgey, JAA

PY - 2008/8

Y1 - 2008/8

N2 - Background: The optimal waveform tilt for defibrillation is not known. Most modern defibrillators used for the cardioversion of atrial fibrillation (AF) employ high-tilt, capacitor-based biphasic waveforms. Methods: We have developed a low-tilt biphasic waveform for defibrillation. This low-tilt waveform was compared with a conventional waveform of equivalent duration and voltage in patients with AF. Patients with persistent AF or AF induced during a routine electrophysiology study (EPS) were randomized to receive either the low-tilt waveform or a conventional waveform. Defibrillation electrodes were positioned in the right atrial appendage and distal coronary sinus. Phase 1 peak voltage was increased in a stepwise progression from 50 V to 300V Shock success was defined as return of sinus rhythm for >= 30 seconds. Results: The low-tilt waveform produced successful termination of persistent AF at a mean voltage of 223 V (8.2 J) versus 270 V (6.7 J) with the conventional waveform (P = 0.002 for voltage, P = ns for energy). In patients with induced AF the mean voltage for the low-tilt waveform was 91 V (1.6 J) and for the conventional waveform was 158 V (2.0 J) (P = 0.005 for voltage, P = ns for energy). The waveform was much more successful at very low voltages (less than or equal to 100 V) compared with the conventional waveform (Novel: 82% vs Conventional 22%, P = 0.008). Conclusion: The low-tilt biphasic waveform was more successful for the internal cardioversion of both persistent and induced AF in patients (in terms of leading edge voltage).

AB - Background: The optimal waveform tilt for defibrillation is not known. Most modern defibrillators used for the cardioversion of atrial fibrillation (AF) employ high-tilt, capacitor-based biphasic waveforms. Methods: We have developed a low-tilt biphasic waveform for defibrillation. This low-tilt waveform was compared with a conventional waveform of equivalent duration and voltage in patients with AF. Patients with persistent AF or AF induced during a routine electrophysiology study (EPS) were randomized to receive either the low-tilt waveform or a conventional waveform. Defibrillation electrodes were positioned in the right atrial appendage and distal coronary sinus. Phase 1 peak voltage was increased in a stepwise progression from 50 V to 300V Shock success was defined as return of sinus rhythm for >= 30 seconds. Results: The low-tilt waveform produced successful termination of persistent AF at a mean voltage of 223 V (8.2 J) versus 270 V (6.7 J) with the conventional waveform (P = 0.002 for voltage, P = ns for energy). In patients with induced AF the mean voltage for the low-tilt waveform was 91 V (1.6 J) and for the conventional waveform was 158 V (2.0 J) (P = 0.005 for voltage, P = ns for energy). The waveform was much more successful at very low voltages (less than or equal to 100 V) compared with the conventional waveform (Novel: 82% vs Conventional 22%, P = 0.008). Conclusion: The low-tilt biphasic waveform was more successful for the internal cardioversion of both persistent and induced AF in patients (in terms of leading edge voltage).

KW - atrial fibrillation

KW - direct current cardioversion

M3 - Article

VL - 31

SP - 1020

EP - 1024

JO - Pace-Pacing and Clinical Electrophysiology

T2 - Pace-Pacing and Clinical Electrophysiology

JF - Pace-Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 8

ER -