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Prospective, randomized comparison of two biphasic waveforms for the efficacy and safety of transthoracic biphasic cardioversion of atrial fibrillation.

Abstract：

OBJECTIVES:The purpose of this study was to determine if there is a difference in commercially available biphasic waveforms. BACKGROUND:Although the superiority of biphasic over monophasic waveforms for external cardioversion of atrial fibrillation (AF) is established, the relative efficacy of available biphasic waveforms is less clear. METHODS:We compared the effectiveness of a biphasic truncated exponential (BTE) waveform and a biphasic rectilinear (BR) waveform for external cardioversion of AF. Patients (N = 188) with AF were randomized to receive transthoracic BR shocks (50, 75, 100, 120, 150, 200 J) or BTE shocks (50, 70, 100, 125, 150, 200, 300, 360 J). Shock strength was escalated until success or maximum energy dose was achieved. If maximum shock strength failed, patients received the maximum shock of the opposite waveform. Analysis included 141 patients (71 BR, 70 BTE; mean age 66.5 +/- 13.7. Forty-seven randomized patients were excluded because of flutter on precardioversion ECG upon blinded review (n = 25), presence of intracardiac thrombus (n = 7), or protocol deviation (n = 15). Groups were similar with regard to clinical and echocardiographic characteristics. RESULTS:The success rate was similar for the two waveforms (93% BR vs 97 BTE, P = .44), although cumulative selected and delivered energy was less in the BTE group. Only AF duration was significantly different between successful and unsuccessful patients. No significant complications occurred. CONCLUSIONS:Biphasic waveforms were very effective in transthoracic cardioversion of AF, and complication rates were low. No significant difference in efficacy was observed between BR and BTE waveforms. Impedance was not an important determinant of success for either biphasic waveform.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Alatawi F,Gurevitz O,White RD,Ammash NM,Malouf JF,Bruce CJ,Moon BS,Rosales AG,Hodge D,Hammill SC,Gersh BJ,Friedman PA

doi

10.1016/j.hrthm.2004.12.024

keywords:

subject

Has Abstract

pub_date

2005-04-01 00:00:00

pages

382-7

issue

4

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(05)00007-X

journal_volume

2

pub_type

临床试验,杂志文章,随机对照试验

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