Effect of Electrode Polarity on Internal Defibrillation with Monophasic and Biphasic Waveforms Using an Endocardial Lead System

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Abstract
Defibrillation Electrode Polarity. introduction: To test the hypothesis that the effect of shock polarity on defibrillation depends on waveform duration, this study determined strength‐duration defibrillation curves of monophasic and biphasic truncated exponential waveforms for both polarities. Methods and Results: Defibrillation thresholds (DFTs) were obtained in 32 pigs for catheter electrodes in the right ventricle (RV) and superior vena cava (SVC) using a modified Purdue technique. Both electrode polarities were tested in five different protocols. In part 1, DFTs were determined with 1‐ to 14‐msec monophasic waveforms. In parts 2, 3, and 4, DFTs were determined with two different sizes of SVC electrodes for biphasic waveforms with a phase 1 of 4 or 6 msec and a phase 2 ranging from 1 to 10 msec. In part 5, DFTs were tested for monophasic waveforms ranging from 2 to 11 msec and for biphasic waveforms with a phase 1 duration corresponding to each monophasic waveform and a phase 2 held constant at 1 msec. Mean DFTs for monophasic waveforms were significantly lower when the RV electrode was an anode than when it was a cathode for waveform durations ≥ 3 msec. For biphasic waveforms in which phase 2 was ≤ phase 1 in duration, no significant difference in mean DFT was observed when polarity was reversed. Even a phase 2 as short as 1 msec could eliminate the DFT difference between polarities observed with monophasic shocks. When phase 2 was ≥ 2 msec longer than phase 1, polarity did affect the DFT of biphasic waveforms: it affected the DFT similarly to a monophasic waveform of the same polarity as phase 2. Phase 1 duration and electrode size also affected the difference in DFT produced by changing the electrode polarity. Conclusions: For phase durations most commonly used clinically because of their low DFTs. reversing polarity changed defibrillation efficacy for monophasic but not biphasic shocks. For inefficient biphasic waveforms with phase 2 ≥ 2 msec longer than phase 1, the DFT was lower when the RV electrode was an anode during phase 2, similar to the polarity difference for monopbasic waveforms, suggesting that a long second phase of biphasic waveforms defibrillates in a similar fashion to monophasic waveforms.