Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial
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Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial. / Mortensen, Kai; Risius, Tim; Schwemer, Tjark F; Aydin, Muhammet Ali; Köster, Ralf; Klemm, Hanno U; Lutomsky, Boris; Meinertz, Thomas; Ventura, Rodolfo; Willems, Stephan.
In: CARDIOLOGY, Vol. 111, No. 1, 2008, p. 57-62.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial
AU - Mortensen, Kai
AU - Risius, Tim
AU - Schwemer, Tjark F
AU - Aydin, Muhammet Ali
AU - Köster, Ralf
AU - Klemm, Hanno U
AU - Lutomsky, Boris
AU - Meinertz, Thomas
AU - Ventura, Rodolfo
AU - Willems, Stephan
N1 - (c) 2008 S. Karger AG, Basel.
PY - 2008
Y1 - 2008
N2 - 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.
AB - 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.
KW - Aged
KW - Atrial Flutter/therapy
KW - Electric Countershock/instrumentation
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Treatment Outcome
U2 - 10.1159/000113429
DO - 10.1159/000113429
M3 - SCORING: Journal article
C2 - 18239394
VL - 111
SP - 57
EP - 62
JO - CARDIOLOGY
JF - CARDIOLOGY
SN - 0008-6312
IS - 1
ER -
