Document Detail

A prospective randomized cross-over comparison of mono- and biphasic defibrillation using nonthoracotomy lead configurations in humans.
MedLine Citation:
PMID:  7987528     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: For current implantable defibrillators, the nonthoracotomy approach to implantation fails in a substantial number of patients. In a prospective randomized cross-over study the defibrillation efficacy of a standard monophasic and a new biphasic waveform was compared for different lead configurations. METHODS AND RESULTS: Intraoperatively, in 79 patients receiving nonthoracotomy defibrillation leads, the defibrillation threshold was determined in the initial lead configuration for the mono- and biphasic waveform. In each patient, both waveforms were used alternately with declining energies (20, 15, 10, 5 J) until failure of defibrillation occurred. Three different initial lead configurations were tested in different, consecutive, nonrandomized patients using a bipolar endocardial defibrillation lead alone (A; n = 36) or in combination with a subcutaneous defibrillation patch (B; n = 24) or array (C; n = 19) lead. The lowest successful defibrillation energy with the biphasic waveform was less than, equal to, or higher than with the monophasic waveform in 64%, 28%, and 8% of patients, respectively, and on average significantly lower with the biphasic waveform for all three lead configurations (A: 11.3 +/- 4.4 J vs 14.5 +/- 4.5 J; B: 9.7 +/- 4.7 J vs 15.1 +/- 4.5 J; C: 7.9 +/- 4.5 J vs 12.4 +/- 4.9 J). Defibrillation efficacy at 20 J was significantly improved by the biphasic waveform (91% vs 76%). CONCLUSION: In combination with nonthoracotomy defibrillation leads, the biphasic waveform of a new implantable cardioverter defibrillator showed superior defibrillation efficacy in comparison to the standard monophasic waveform. Defibrillation thresholds were improved for lead systems with and without a subcutaneous patch or array lead.
M Block; D Hammel; D Böcker; M Borggrefe; T Budde; F Isbruch; D Wietholt; H H Scheld; G Breithardt
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  5     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  1994 Jul 
Date Detail:
Created Date:  1995-01-09     Completed Date:  1995-01-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  581-90     Citation Subset:  IM    
Hospital of the Westfälische Wilhelms-University of Münster, Department of Cardiology/Angiology, Germany.
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MeSH Terms
Cross-Over Studies
Defibrillators, Implantable*
Middle Aged
Prospective Studies
Ventricular Fibrillation / radiography,  therapy*

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