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Biphasic versus Monophasic Shock for External Cardioversion of Atrial Flutter

Authors :
Kai Mortensen
Muhammet Ali Aydin
Stephan Willems
Rodolfo Ventura
Tjark F. Schwemer
Tim Risius
Thomas Meinertz
Hanno U. Klemm
Ralf Köster
Boris Lutomsky
Source :
Cardiology. 111:57-62
Publication Year :
2008
Publisher :
S. Karger AG, 2008.

Abstract

Background: External cardioversion is effective to terminate persistent atrial flutter. Biphasic shocks have been shown to be superior to monophasic shocks for ventricular defibrillation and atrial fibrillation cardioversion. The purpose of this trial was to compare the efficacy of rectilinear biphasic versus standard damped sine wave monophasic shocks in symptomatic patients with typical atrial flutter. Methods: 135 consecutive patients were screened, 95 (70 males, mean age 62 ± 13 years) were included. Patients were randomly assigned to a monophasic or biphasic cardioversion protocol. Forty-seven patients randomized to the monophasic protocol received sequential shocks of 100, 150, 200, 300 and 360 J. Forty-eight patients with the biphasic protocol received 50, 75, 100, 150 or 200 J. Results: First-shock efficacy with 50-Joule, biphasic shocks (23/48 patients, 48%) was significantly greater than with the 100-Joule, monophasic waveform (13/47 patients, 28%, p = 0.04). The cumulative second-shock efficacy with the 50- and 75-Joule, biphasic waveform (39/48 patients, 81%) was significantly greater than with the 100- and 150-Joule, monophasic waveform (25/47 patients, 53%, p < 0.05). The cumulative efficacy for the higher energy levels showed naturally no significant difference between the two groups. The amount of the mean delivered energy was significantly lower in the biphasic group (76 ± 39 J) compared to the monophasic one (177 ± 78 J, p < 0.05). Conclusions: For transthoracic cardioversion of typical atrial flutter, biphasic shocks have greater efficacy and the mean delivered current is lower than for monophasic shocks. Therefore, biphasic cardioversion with lower starting energies should be recommended.

Details

ISSN :
14219751 and 00086312
Volume :
111
Database :
OpenAIRE
Journal :
Cardiology
Accession number :
edsair.doi...........9617bb62c7c4035917fe95e8b0ab332a
Full Text :
https://doi.org/10.1159/000113429