© 2001 by European Society of Cardiology
REGULAR ARTICLES
External cardioversion of atrial fibrillation: comparison of biphasic vs monophasic waveform shocks
1University of Marseille France; 2University of Seattle WA, U.S.A
AIMS: It is well established in transthoracic ventricular defibrillation that biphasic truncated waveform shocks are associated with superior defibrillation efficacy when compared with damped sine wave monophasic waveform shocks. The aim of this study was to explore whether biphasic waveform shocks were superior to monophasic waveform shocks for external cardioversion of atrial fibrillation (AF).
METHODS AND RESULTS: Fifty-seven patients in whom cardioversion of AF was indicated were randomized in this prospective study, to transthoracic cardioversion with either monophasic damped sine waveform shocks or biphasic impedance compensating waveform shocks. In the group randomized to monophasic waveform shocks (27 patients), a first shock of 150 J was delivered, followed (if necessary) by a 360 J shock. In the biphasic waveform group (30 patients), the first shock had an energy of 150 J and (if necessary) a second 150 J was delivered. All shocks were delivered in the anterolateral chest pad position.
Sinus rhythm was restored in 16 patients (51%) with the first monophasic shock and in 27 patients (86%) with the first biphasic shock. The difference was statistically significant (P=0·02). After the second shock, sinus rhythm was obtained in a total of 24 patients (88%) with monophasic shocks and in 28 patients (93%) with biphasic shocks. No complication was observed in either group and cardiac enzymes (CK, CKmb, troponin I, myoglobin) did not show any significant changes.
CONCLUSION: This study suggests that at the same energy level of 150 J, biphasic impedance compensating waveform shocks are superior to monophasic damped sine waveform shocks cardioversion of atrial fibrillation.
Key Words: Atrial fibrillation, external cardioversion monophasic shocks, biphasic shocks
Correspondence: Professor Samuel Lévy, MD, Division of Cardiology, Hôpital Nord, 13015 Marseille, France. slevy{at}ap-hm.fr Presented in part at the European Congress of Cardiology, Barcelona, Spain, 1 September 1999.
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