THE EFFECT OF PHASE-SEPARATION ON BIPHASIC WAVE-FORM DEFIBRILLATION

被引:16
作者
COOPER, RAS
WALLENIUS, ST
SMITH, WM
IDEKER, RE
机构
[1] DUKE UNIV,MED CTR,DEPT PATHOL,DURHAM,NC 27710
[2] DUKE UNIV,SCH ENGN,ENGN RES CTR EMERGING CARDIOVASC TECHNOL,DURHAM,NC 27706
来源
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY | 1993年 / 16卷 / 03期
关键词
BIPHASIC WAVE-FORM; PHASE SEPARATION; DEFIBRILLATION;
D O I
10.1111/j.1540-8159.1993.tb01610.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
It has been hypothesized that the defibrillation efficacy of a biphasic shock is caused by the large change in voltage between the two phases. This study examined the effects of separating the two phases in time thus splitting in half the rapid voltage change at phase reversal. The study was performed in three parts each using six dogs. Part I determined defibrillation thresholds (DFTs) for two exponentially truncated biphasic waveforms (3.5/2 msec and 6/6 msec) with interphase time delays of 0, 1, 2, 3, 4, 6, 8, and 10 msec. In Part II, probability of success curves were generated using an up down method with 15 shocks for each delay for the 3.5/2 msec biphasic waveform with interphase delays of 0, 2, 3, 4, and 5 msec. In Part III, DFTs were determined using a 3.512 msec and 6/6 msec biphasic as well as a third waveform that consisted of two sequential 6-msec pulses of the same polarity with interphase delays of 0, 5, 10, 15, 20, 25, 50, and 100 msec. In all three parts the defibrillating cathode was a 6.17 cm2 transvenous spring electrode positioned in the RV apex and the anode was a 113 cm2 cutaneous left chest wall electrode patch. With all waveforms, the trailing edge voltage of the first phase was equal to the negative of the leading edge voltage of the second phase. There was no statistical difference in DFTs or in 50% successful defibrillation points for phase separations from 0 to 6 msec and 0 to 5 msec for Parts I and II, respectively. In Part I there was a significant increase in DFTs for phase separations of 8 and 10 msec compared to a phase separation of 0 msec. In Part III there was no significant difference for separations of 0 and 5 msec; however, there was a significant increase in DFT requirements for separations from 5 to 50 msec, which then decreased with a separation of 100 msec for all three waveforms tested. In conclusion, defibrillation efficacy was unchanged with phase separations up to 6 msec. With phase separation, the rapid voltage change during phase reversal is split in half and, thus, cannot explain the improved efficacy of biphasic waveforms.
引用
收藏
页码:471 / 482
页数:12
相关论文
共 54 条
[1]   EFFECT OF PENTOBARBITAL ANESTHESIA ON VENTRICULAR DEFIBRILLATION THRESHOLD IN DOGS [J].
BABBS, CF .
AMERICAN HEART JOURNAL, 1978, 95 (03) :331-337
[2]   REDUCTION OF ENERGY REQUIRED FOR DEFIBRILLATION BY DELIVERING SHOCKS IN ORTHOGONAL DIRECTIONS IN THE DOG [J].
BARDOU, AL ;
DEGONDE, J ;
BIRKUI, PJ ;
AUGER, P ;
CHESNAIS, JM ;
DURIEZ, M .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1988, 11 (11) :1990-1995
[3]  
BOURLAND JD, 1986, MED INSTRUM, V20, P138
[4]  
BOURLAND JD, 1978, MED INSTRUM, V12, P38
[5]   DOUBLE AND TRIPLE SEQUENTIAL SHOCKS REDUCE VENTRICULAR DEFIBRILLATION THRESHOLD IN DOGS WITH AND WITHOUT MYOCARDIAL-INFARCTION [J].
CHANG, MS ;
INOUE, H ;
KALLOK, MJ ;
ZIPES, DP .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 8 (06) :1393-1405
[6]  
CHAPMAN P D, 1988, Journal of the American College of Cardiology, V11, p57A
[7]  
CHAPMAN PD, 1988, PACE, V11, P497
[8]  
COOPER RAS, 1992, IMPLANTABLE CARDIOVE, P97
[9]   MYOCARDIAL NECROSIS FROM DIRECT-CURRENT COUNTERSHOCK - EFFECT OF PADDLE ELECTRODE SIZE AND TIME INTERVAL BETWEEN DISCHARGES [J].
DAHL, CF ;
EWY, GA ;
WARNER, ED ;
THOMAS, ED .
CIRCULATION, 1974, 50 (05) :956-961
[10]   THE RELATIONSHIP BETWEEN SUCCESSFUL DEFIBRILLATION AND DELIVERED ENERGY IN OPEN-CHEST DOGS - REAPPRAISAL OF THE DEFIBRILLATION THRESHOLD CONCEPT [J].
DAVY, JM ;
FAIN, ES ;
DORIAN, P ;
WINKLE, RA .
AMERICAN HEART JOURNAL, 1987, 113 (01) :77-84