Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation

SJ Walsh, G Manoharan, OJ Escalona, JA Santos, N Evans, JMCC Anderson, M Stevenson, JD Allen, AAJ Adgey

Research output: Contribution to journalArticle

Abstract

Aims: To investigate the feasibility and efficacy of novel low-tilt biphasic waveforms in transvenouscardioversion of atrial fibrillation (AF), delivered by a radiofrequency-powered defibrillator.Methods and results: The investigation was performed in three phases in an animal model of AF: a feasibility and efficacy study (in 10 adult Large White Landrace swine), comparison with low-tilt monophasic and standard capacitor-based waveforms, and an assessment of sequential shocks delivered over several pathways (in 15 adult Suffolk sheep). Defibrillation electrodes were positioned transvenously under fluoroscopic control in the high lateral right atrium and distal coronary sinus. When multiple defibrillation pathways were tested, a third electrode was also attached to the lower interatrial septum. The electrodes were then connected to a radiofrequency (RF)-powered defibrillator or a standard defibrillator. After confirmation of successful induction of sustained AF, defibrillation was attempted. Percentage success was calculated from the effects of all shocks delivered to all the animals within each set of experiments. Of the low-tilt (RF) biphasic waveforms delivered during internal atrial cardioversion, 100% success was achieved with a 6/6 ms 100/250 V waveform (1.45+/-0.01 J). This waveform was similar in efficacy to low-tilt (RF) monophasic waveforms (88 vs. 92% success, 1.58+/-0.01 vs. 2.67+/-0.03 J; P = NS; delivered energy 41% lower) and superior to equivalent voltage standard monophasic (50% success, 0.67+/-0.00 J; P <0.001) and biphasic waveforms (72% success, 0.69+/-0.00 J; P = 0.03). Sequential shocks delivered over dual pathways did not improve the efficacy of low-tilt biphasic waveforms.Conclusion: A low-tilt biphasic waveform from a RF-powered defibrillator (6/6 ms, 100/250 V) ismore efficacious than standard monophasic or biphasic waveforms (equivalent voltage) and is similar in efficacy to low-tilt monophasic waveforms.
LanguageEnglish
Pages873-880
JournalEP - Europace
Volume8
Publication statusPublished - 15 Oct 2006

Fingerprint

Electric Countershock
Defibrillators
Atrial Fibrillation
Shock
Electrodes
Coronary Sinus
Feasibility Studies
Heart Atria
Sheep
Swine
Animal Models

Keywords

  • Atrial Fibrillation
  • Cardioversion
  • Implantable Defibrillator
  • RF Defibrillation
  • Biphasic Waveform
  • AF
  • ECG
  • Cardiology.

Cite this

@article{0bf0a0a525a747839f12dffb21e24e78,
title = "Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation",
abstract = "Aims: To investigate the feasibility and efficacy of novel low-tilt biphasic waveforms in transvenouscardioversion of atrial fibrillation (AF), delivered by a radiofrequency-powered defibrillator.Methods and results: The investigation was performed in three phases in an animal model of AF: a feasibility and efficacy study (in 10 adult Large White Landrace swine), comparison with low-tilt monophasic and standard capacitor-based waveforms, and an assessment of sequential shocks delivered over several pathways (in 15 adult Suffolk sheep). Defibrillation electrodes were positioned transvenously under fluoroscopic control in the high lateral right atrium and distal coronary sinus. When multiple defibrillation pathways were tested, a third electrode was also attached to the lower interatrial septum. The electrodes were then connected to a radiofrequency (RF)-powered defibrillator or a standard defibrillator. After confirmation of successful induction of sustained AF, defibrillation was attempted. Percentage success was calculated from the effects of all shocks delivered to all the animals within each set of experiments. Of the low-tilt (RF) biphasic waveforms delivered during internal atrial cardioversion, 100{\%} success was achieved with a 6/6 ms 100/250 V waveform (1.45+/-0.01 J). This waveform was similar in efficacy to low-tilt (RF) monophasic waveforms (88 vs. 92{\%} success, 1.58+/-0.01 vs. 2.67+/-0.03 J; P = NS; delivered energy 41{\%} lower) and superior to equivalent voltage standard monophasic (50{\%} success, 0.67+/-0.00 J; P <0.001) and biphasic waveforms (72{\%} success, 0.69+/-0.00 J; P = 0.03). Sequential shocks delivered over dual pathways did not improve the efficacy of low-tilt biphasic waveforms.Conclusion: A low-tilt biphasic waveform from a RF-powered defibrillator (6/6 ms, 100/250 V) ismore efficacious than standard monophasic or biphasic waveforms (equivalent voltage) and is similar in efficacy to low-tilt monophasic waveforms.",
keywords = "Atrial Fibrillation, Cardioversion, Implantable Defibrillator, RF Defibrillation, Biphasic Waveform, AF, ECG, Cardiology.",
author = "SJ Walsh and G Manoharan and OJ Escalona and JA Santos and N Evans and JMCC Anderson and M Stevenson and JD Allen and AAJ Adgey",
year = "2006",
month = "10",
day = "15",
language = "English",
volume = "8",
pages = "873--880",
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Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation. / Walsh, SJ; Manoharan, G; Escalona, OJ; Santos, JA; Evans, N; Anderson, JMCC; Stevenson, M; Allen, JD; Adgey, AAJ.

In: EP - Europace, Vol. 8, 15.10.2006, p. 873-880.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Novel rectangular biphasic and monophasic waveforms delivered by a radiofrequency-powered defibrillator compared with conventional capacitor-based waveforms in transvenous cardioversion of atrial fibrillation

AU - Walsh, SJ

AU - Manoharan, G

AU - Escalona, OJ

AU - Santos, JA

AU - Evans, N

AU - Anderson, JMCC

AU - Stevenson, M

AU - Allen, JD

AU - Adgey, AAJ

PY - 2006/10/15

Y1 - 2006/10/15

N2 - Aims: To investigate the feasibility and efficacy of novel low-tilt biphasic waveforms in transvenouscardioversion of atrial fibrillation (AF), delivered by a radiofrequency-powered defibrillator.Methods and results: The investigation was performed in three phases in an animal model of AF: a feasibility and efficacy study (in 10 adult Large White Landrace swine), comparison with low-tilt monophasic and standard capacitor-based waveforms, and an assessment of sequential shocks delivered over several pathways (in 15 adult Suffolk sheep). Defibrillation electrodes were positioned transvenously under fluoroscopic control in the high lateral right atrium and distal coronary sinus. When multiple defibrillation pathways were tested, a third electrode was also attached to the lower interatrial septum. The electrodes were then connected to a radiofrequency (RF)-powered defibrillator or a standard defibrillator. After confirmation of successful induction of sustained AF, defibrillation was attempted. Percentage success was calculated from the effects of all shocks delivered to all the animals within each set of experiments. Of the low-tilt (RF) biphasic waveforms delivered during internal atrial cardioversion, 100% success was achieved with a 6/6 ms 100/250 V waveform (1.45+/-0.01 J). This waveform was similar in efficacy to low-tilt (RF) monophasic waveforms (88 vs. 92% success, 1.58+/-0.01 vs. 2.67+/-0.03 J; P = NS; delivered energy 41% lower) and superior to equivalent voltage standard monophasic (50% success, 0.67+/-0.00 J; P <0.001) and biphasic waveforms (72% success, 0.69+/-0.00 J; P = 0.03). Sequential shocks delivered over dual pathways did not improve the efficacy of low-tilt biphasic waveforms.Conclusion: A low-tilt biphasic waveform from a RF-powered defibrillator (6/6 ms, 100/250 V) ismore efficacious than standard monophasic or biphasic waveforms (equivalent voltage) and is similar in efficacy to low-tilt monophasic waveforms.

AB - Aims: To investigate the feasibility and efficacy of novel low-tilt biphasic waveforms in transvenouscardioversion of atrial fibrillation (AF), delivered by a radiofrequency-powered defibrillator.Methods and results: The investigation was performed in three phases in an animal model of AF: a feasibility and efficacy study (in 10 adult Large White Landrace swine), comparison with low-tilt monophasic and standard capacitor-based waveforms, and an assessment of sequential shocks delivered over several pathways (in 15 adult Suffolk sheep). Defibrillation electrodes were positioned transvenously under fluoroscopic control in the high lateral right atrium and distal coronary sinus. When multiple defibrillation pathways were tested, a third electrode was also attached to the lower interatrial septum. The electrodes were then connected to a radiofrequency (RF)-powered defibrillator or a standard defibrillator. After confirmation of successful induction of sustained AF, defibrillation was attempted. Percentage success was calculated from the effects of all shocks delivered to all the animals within each set of experiments. Of the low-tilt (RF) biphasic waveforms delivered during internal atrial cardioversion, 100% success was achieved with a 6/6 ms 100/250 V waveform (1.45+/-0.01 J). This waveform was similar in efficacy to low-tilt (RF) monophasic waveforms (88 vs. 92% success, 1.58+/-0.01 vs. 2.67+/-0.03 J; P = NS; delivered energy 41% lower) and superior to equivalent voltage standard monophasic (50% success, 0.67+/-0.00 J; P <0.001) and biphasic waveforms (72% success, 0.69+/-0.00 J; P = 0.03). Sequential shocks delivered over dual pathways did not improve the efficacy of low-tilt biphasic waveforms.Conclusion: A low-tilt biphasic waveform from a RF-powered defibrillator (6/6 ms, 100/250 V) ismore efficacious than standard monophasic or biphasic waveforms (equivalent voltage) and is similar in efficacy to low-tilt monophasic waveforms.

KW - Atrial Fibrillation

KW - Cardioversion

KW - Implantable Defibrillator

KW - RF Defibrillation

KW - Biphasic Waveform

KW - AF

KW - ECG

KW - Cardiology.

M3 - Article

VL - 8

SP - 873

EP - 880

JO - EP - Europace

T2 - EP - Europace

JF - EP - Europace

SN - 1099-5129

ER -