ASL LE/2 Maglie - PRESIDIO OSPEDALIERO "F.FERRARI" - CASARANO (LE) DIVISIONE DI CARDIOLOGIA UNITA' CORONARICA
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EXTERNAL ELECTRICAL
CARDIOVERSIQN OF ATRIAL FIBRILLATION: RECTILINEAR BIPHASIC VS MONOPHASIC
SHOCK
Pettinati G. - Storti G. - Marzo A. - Portone
F. - Muscella A. Cardiology department, F. Ferrari Hospital Casarano (Lecce) Italy MEDITERRANEAN JOURNAL OF PACING AND ELECTROPHISIOLOGY (MESPE) Vol.
3 n.3 July-Septembre 2001 American College of Cardiology - May 1, 2002, Volume 39, Number 9 (supplement B) In recent clinical studies, electrical cardioversion of atrial
fibrillation has been shown to be more effective and to require less energy if a
rectilinear biphasic waveform is used instead of the traditional monophasic one. METHODTo investigate this hypothesis, we prospectively randomized 40 patients
(26 M, 14 F, age 58±16) affected by atrial fibrillation. 20 patients were
treated with rectilinear biphasic shock (RBS) and 20 patients with monophasic
shock (MS). Both groups were delivered with increasing energy levels (50 75 100
150 - 200 J for RBS and 100 150 200 300 - 360 J for MS). Rectilinear
biphasic shocks, generated from a Biphasic M series (ZOLL Medical Corporation),
consisted of a constant current 6ms first phase pulse followed by a truncated
exponential 4ms second phase pulse; monophasic shocks were generated from ZOLL
PD2000 (ZOLL Medical Corporation). In both groups, adhesive pads were in
anterior/posterior position. RESULTS19/20 patients in group RBS (95%) and 17/20 patients in group MS (85%) achieved normal sinus rhythm. First shock efficacy was 68% in group RBS (13/19) and 52.9% in group MS (9/17). In patients with atrial fibrillation, first rectilinear biphasic shock achieved normal sinus rhythm in 68% of cases with less energy (50J) compored with first monophasic shock resulting in effective cardioversion in only 52% of patients with higher energy Ievel (1OOJ) and even higher in the rest of the group. To achieve normal sinus rhythm a Iower amount of energy (2450J vs 3900J) and a lower mean energy/patient (128.9J vs 229.4J) was delivered in the RBS group compared with the MS group, with a mean reduction in the energy/patient of 100J. CONCLUSIONIn
atrial fibrillation, rectilinear biphasic transthoracic shock is more effective
than monophasic shock and less energy is required, resulting in Iess post shock
disfunction and shorter sedation. |
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