Document Detail

Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial.
MedLine Citation:
PMID:  18239394     Owner:  NLM     Status:  MEDLINE    
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.
Kai Mortensen; Tim Risius; Tjark F Schwemer; Muhammet Ali Aydin; Ralf Köster; Hanno U Klemm; Boris Lutomsky; Thomas Meinertz; Rodolfo Ventura; Stephan Willems
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2008-02-01
Journal Detail:
Title:  Cardiology     Volume:  111     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2008  
Date Detail:
Created Date:  2008-07-29     Completed Date:  2008-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  57-62     Citation Subset:  IM    
Copyright Information:
(c) 2008 S. Karger AG, Basel.
Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany.
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MeSH Terms
Atrial Flutter / therapy*
Electric Countershock / instrumentation*,  methods
Middle Aged
Prospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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