COMPARISON OF BIPHASIC AND MONOPHASIC SHOCKS FOR DEFIBRILLATION USING A NONTHORACOTOMY SYSTEM

被引:74
作者
WYSE, DG
KAVANAGH, KM
GILLIS, AM
MITCHELL, LB
DUFF, HJ
SHELDON, RS
KIESER, TM
MAITLAND, A
FLANAGAN, P
ROTHSCHILD, J
MEHRA, R
机构
[1] MEDTRONIC INC,MINNEAPOLIS,MN
[2] UNIV CALGARY,FOOTHILLS HOSP,DIV CARDIOVASC SURG,CALGARY T2N 2T9,AB,CANADA
关键词
D O I
10.1016/0002-9149(93)90738-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A comparison of defibrillation thresholds was made using biphasic and monophasic shocks delivered by a nonthoracotomy lead system in 2 clinically distinct groups of patients. The first group were patients receiving an implantable cardioverter-defibrillator who were studied before surgery with their chests closed. The second group were patients undergoing coronary artery bypass grafting (CABG) who were studied before surgery with their chests open but reapproximated. Biphasic defibrillation thresholds (stored energy) were significantly (p < 0.001) less than monophasic ones in subjects with the implantable cardioverter-defibrillator (12.3 +/- 5.3 vs 21.1 +/- 9.3 J) or CABG (14.6 +/- 7.1 vs 24.2 +/- 12.6 J). These values are less than were previously reported with a similar nonthoracotomy lead configuration. There were no significant differences between the 2 groups in all measurements derived from corresponding shock waveforms, although impedance tended to be greater in patients with CABG. However, subjects with CABG had greater left ventricular ejection fractions and did not have history of potentially lethal ventricular arrhythmias. Despite these differences, the conclusion that biphasic shocks are more effective would have been made in a study of either group alone. It is concluded that patients with CABG who have not had preceding potentially lethal ventricular arrhythmias may be a potential source of surrogate subjects for defibrillation research such as epicardial mapping, which requires that the chest be open.
引用
收藏
页码:197 / 202
页数:6
相关论文
共 32 条
[1]   A PROSPECTIVE, RANDOMIZED EVALUATION OF EFFECT OF VENTRICULAR-FIBRILLATION DURATION ON DEFIBRILLATION THRESHOLDS IN HUMANS [J].
BARDY, GH ;
IVEY, TD ;
ALLEN, M ;
JOHNSON, G .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 13 (06) :1362-1366
[2]   A PROSPECTIVE RANDOMIZED EVALUATION OF BIPHASIC VERSUS MONOPHASIC WAVEFORM PULSES ON DEFIBRILLATION EFFICACY IN HUMANS [J].
BARDY, GH ;
IVEY, TD ;
ALLEN, MD ;
JOHNSON, G ;
MEHRA, R ;
GREENE, HL .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (03) :728-733
[3]  
BIGGER JT, 1991, PACE, V14, P883
[4]   COMPARATIVE EFFICACY OF MONOPHASIC AND BIPHASIC TRUNCATED EXPONENTIAL SHOCKS FOR NONTHORACOTOMY INTERNAL DEFIBRILLATION IN DOGS [J].
CHAPMAN, PD ;
VETTER, JW ;
SOUZA, JJ ;
TROUP, PJ ;
WETHERBEE, JN ;
HOFFMANN, RG .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (03) :739-745
[5]  
CHAPMAN PD, 1987, AM HEART J, V5114, P274
[6]   ELECTRODE PAD SIZE, TRANS-THORACIC IMPEDANCE AND SUCCESS OF EXTERNAL VENTRICULAR DEFIBRILLATION [J].
DALZELL, GWN ;
CUNNINGHAM, SR ;
ANDERSON, J ;
ADGEY, AAJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1989, 64 (12) :741-744
[7]   IMPROVED DEFIBRILLATION THRESHOLDS WITH LARGE CONTOURED EPICARDIAL ELECTRODES AND BIPHASIC WAVE-FORMS [J].
DIXON, EG ;
TANG, ASL ;
WOLF, PD ;
MEADOR, JT ;
FINE, MJ ;
CALFEE, RV ;
IDEKER, RE .
CIRCULATION, 1987, 76 (05) :1176-1184
[8]   LIDOCAINE CAUSES A REVERSIBLE, CONCENTRATION-DEPENDENT INCREASE IN DEFIBRILLATION ENERGY-REQUIREMENTS [J].
DORIAN, P ;
FAIN, ES ;
DAVY, JM ;
WINKLE, RA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 8 (02) :327-332
[9]   EVALUATION OF ANTIARRHYTHMIC DRUGS ON DEFIBRILLATION ENERGY-REQUIREMENTS IN DOGS - SODIUM-CHANNEL BLOCK AND ACTION-POTENTIAL PROLONGATION [J].
ECHT, DS ;
BLACK, JN ;
BARBEY, JT ;
COXE, DR ;
CATO, E .
CIRCULATION, 1989, 79 (05) :1106-1117
[10]   EFFECTS OF ENCAINIDE AND ITS METABOLITES ON ENERGY-REQUIREMENTS FOR DEFIBRILLATION [J].
FAIN, ES ;
DORIAN, P ;
DAVY, JM ;
KATES, RE ;
WINKLE, RA .
CIRCULATION, 1986, 73 (06) :1334-1341