Optimization of transthoracic ventricular defibrillation-biphasic and triphasic shocks, waveform rounding, and synchronized shock delivery

The aim of this study is to optimize the truncated exponential waveform for transthoracic ventricular defibrillation. Discharge of a capacitor gives a fast-rising waveform with a spike; rounding of the waveform slows the rate of rise and removes the spike. Defibrillation thresholds for electrically induced VF were determined for rounded and conventional biphasic and triphasic waveforms (apex-anterior paddles; 130 microF capacitor; 3-10 ms phase duration), and for the Lown waveform in 29 anesthetized pigs. Rounding of the leading edge of the biphasic waveform reduced the threshold voltage and current for defibrillation at 3 + 3 ms and 6 + 6 ms phase duration, relative to the conventional unrounded biphasic or the Lown waveforms. The threshold delivered energy was lower for rounded truncated exponential biphasic shocks at 3 + 3 ms (55.3 +/- 2.5 J) than at 6 + 6 ms (67.6 +/- 2.9 J; reduction 15.9 +/- 3.8%; P <.001; n = 29) phase duration. Triphasic shocks (total duration 6-12 ms) showed no advantages over biphasic shocks in this model. The rounded waveform (6 + 6 ms phase duration) had a reduced delivered energy at threshold (9%) with transthoracic shock delivery synchronized to peak (71.1 +/- 4.2 J) or trough (71.5 +/- 4.9 J) of the high amplitude body surface electrocardiogram signal in ventricular fibrillation, compared with unsynchronized shocks (78.7 +/- 4.7 J; P <.05). In this study a biphasic, rounded waveform of total duration 6 or 12 ms, was optimal for the correction of electrically-induced ventricular fibrillation. Synchronization to the peak or trough of the high amplitude electrocardiogram signal gave a further reduction in the energy to defibrillate.