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

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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).
Original languageEnglish
Pages (from-to)1020-1024
JournalPace-Pacing and Clinical Electrophysiology
Issue number8
Publication statusPublished - Aug 2008



  • atrial fibrillation
  • direct current cardioversion

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