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June 17, 2004Prehospital Emergency Care

Efficacy of lower-energy biphasic shocks for transthoracic defibrillation:*1A follow-up clinical study

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Why the study?

Does a 150-J biphasic truncated exponential shock provide equivalent first-shock defibrillation efficacy compared to a 200-J monophasic damped sine shock in patients with electrically-induced ventricular tachyarrhythmias?

Population

96 patients undergoing electrophysiologic testing for ventricular arrhythmias or testing of an implantable…

Comparison

150-joule impedance-compensated, 200-microF… vs Historical control group treated with 200-J…

Design

Cohort

Authors

SHSusan A. HigginsRutgers, The State University of New Jersey

Discussion

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Implication

Supports 150-J BTE for VF; leaves open confirmation of equivalence and outcomes in randomized trials.

Key Points

  • To evaluate the first-shock defibrillation efficacy of 150-J impedance-compensated biphasic truncated exponential shocks in patients with induced ventricular fibrillation compared with historical 200-J monophasic shocks.
  • Prospective interventional trial involving 96 patients undergoing electrophysiologic testing or implantable cardioverter-defibrillator testing with electrically induced ventricular tachyarrhythmias.
  • Delivered 150-J impedance-compensated biphasic truncated exponential (BTE) shocks as primary therapy in the electrophysiology cohort and as rescue therapy after failed device shocks in the defibrillator cohort.
  • Compared outcomes against a historical control group treated with 200-J monophasic damped sine (MDS) shocks.
  • First-shock success for ventricular fibrillation occurred in 97.4% (75/77) of patients receiving 150-J BTE shocks compared with 89.7% (61/68) in historical controls receiving 200-J MDS shocks (p=0.001 for technical equivalence).
  • First-shock conversion for ventricular tachycardia was achieved in 100% (19/19) with 150-J BTE shocks versus 94% (29/31) with 200-J MDS shocks.
  • Delivered peak current was approximately 50% lower with 150-J BTE waveforms than with 200-J MDS waveforms, despite equivalent transthoracic impedance across groups.

Structured PICO

Does a 150-J biphasic truncated exponential shock provide equivalent first-shock defibrillation efficacy compared to a 200-J monophasic damped sine shock in patients with electrically-induced ventricular tachyarrhythmias?

P
Population
96 patients undergoing electrophysiologic (EP) testing for ventricular arrhythmias or testing of an implantable cardioverter-defibrillator (ICD) with electrically-induced ventricular fibrillation (VF) or ventricular tachycardia (VT)
I
Intervention
150-joule impedance-compensated, 200-microF biphasic truncated exponential (BTE) shocks
C
Comparator
Historical control group treated with 200-J monophasic damped sine (MDS) shocks
O
Outcome
First-shock defibrillation efficacy (success rate)surrogate

Lower-energy (150-J) biphasic shocks provide equivalent first-shock defibrillation efficacy to 200-J monophasic shocks for electrically-induced VF, while delivering significantly less peak current.

Cite This Study

Susan A. Higgins (2004) studied this question.

synapsesocial.com/papers/6a70ab5378a11c550e0aa37ehttps://doi.org/10.1016/j.prehos.2004.02.002
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Effects of Ventricular Fibrillation Duration and a Preceding Unsuccessful Shock on the Probability of Defibrillation Success Using Biphasic Waveforms in Pigs1997 · 10 citations
  2. 2A C OMPARISON OF B IPHASIC AND M ONOPHASIC S HOCKS FOR E XTERNAL D EFIBRILLATION2000 · 90 citations
  3. 3Multicenter Comparison of Truncated Biphasic Shocks and Standard Damped Sine Wave Monophasic Shocks for Transthoracic Ventricular Defibrillation1996 · 208 citations
  4. 4Comparison of a novel rectilinear biphasic waveform with a damped sine wave monophasic waveform for transthoracic ventricular defibrillation1999 · 112 citations