Transthoracic Defibrillation of Swine With Monophasic and Biphasic Waveforms

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Abstract
Background Biphasic waveforms have had a favorable impact on internal defibrillation but have seen minimal use in transthoracic defibrillation systems. The purpose of this study was to compare monophasic and biphasic waveforms for transthoracic defibrillation in swine. Methods and Results Three interrelated studies were performed in 19 swine to establish the relative transthoracic defibrillation efficacy of biphasic shock waveforms. In study 1, we measured voltage (V50) and energy (E50) strength-duration curves for monophasic and biphasic truncated exponential waveforms. We then independently examined the effects of phase duration and tilt on biphasic waveform defibrillation with a total waveform duration from study 1 that provided the minimum V50 (study 2) and the minimum E50 (study 3). At each pulse duration tested in study 1, biphasic waveforms defibrillated with significantly less voltage and energy than monophasic waveforms. At a duration of 12 ms, there was a voltage minimum for biphasic waveform defibrillation. At this duration, V50 was 1378±505 V for the biphasic waveform compared with 2185±361 V for the monophasic waveform, P=.01. For both monophasic and biphasic waveforms, E50 increased with pulse duration. With a total pulse duration of 12 ms, E50 was 169±101 J for the biphasic waveform compared with 414±114 J for the monophasic waveform, P=.003. In study 2, optimization of phase duration and total tilt reduced the defibrillation requirements of the 12-ms “minimum voltage” biphasic waveform to 1284±187 V and 129±36 J. In study 3, the 8-ms “minimum energy” biphasic waveform had an E50 of 115±35 J that was 11% less than the 12-ms biphasic waveform, P=.11; however, voltage requirements of 1476±239 V were 15% higher, P=.005. Conclusions This study demonstrates the superiority of truncated biphasic waveforms over truncated monophasic waveforms for transthoracic defibrillation of swine. Biphasic waveforms should prove as advantageous at reducing voltage and energy requirements for transthoracic defibrillation as they have for internal defibrillation.