Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial
Background Several different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB s...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-03-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.004853 |
| _version_ | 1828405580911345664 |
|---|---|
| author | Anders S. Schmidt Kasper G. Lauridsen Kasper Adelborg Peter Torp Leif F. Bach Simon M. Jepsen Nete Hornung Charles D. Deakin Hans Rickers Bo Løfgren |
| author_facet | Anders S. Schmidt Kasper G. Lauridsen Kasper Adelborg Peter Torp Leif F. Bach Simon M. Jepsen Nete Hornung Charles D. Deakin Hans Rickers Bo Løfgren |
| author_sort | Anders S. Schmidt |
| collection | DOAJ |
| description | Background Several different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB shocks with biphasic truncated exponential (BTE) shocks in patients undergoing cardioversion of atrial fibrillation or ‐flutter. Methods and Results This prospective, randomized study included patients admitted for elective direct current cardioversion. Patients were randomized to receive cardioversion using either PB or BTE shocks. We used escalating shocks until sinus rhythm was obtained or to a maximum of 4 shocks. Patients randomized to PB shocks received 90, 120, 150, and 200 J and patients randomized to BTE shocks received 100, 150, 200, and 250 J, as recommended by the manufacturers. In total, 69 patients (51%) received PB shocks and 65 patients (49%) BTE shocks. Successful cardioversion, defined as sinus rhythm 4 hours after cardioversion, was achieved in 43 patients (62%) using PB shocks and in 56 patients (86%) using BTE shocks; ratio 1.4 (95% CI 1.1–1.7) (P=0.002). There was no difference in safety (ie, myocardial injury judged by changes in high‐sensitive troponin I levels; ratio 1.1) (95% CI 1.0–1.3), P=0.15. The study was terminated prematurely because of an adverse event. Conclusions Cardioversion using a BTE waveform was more effective when compared with a PB waveform. There was no difference in safety between the 2 waveforms, as judged by changes in troponin I levels. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02317029. |
| first_indexed | 2024-12-10T10:55:57Z |
| format | Article |
| id | doaj.art-6f0bd2927aff476986326376266e93d7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-10T10:55:57Z |
| publishDate | 2017-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6f0bd2927aff476986326376266e93d72022-12-22T01:51:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-03-016310.1161/JAHA.116.004853Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical TrialAnders S. Schmidt0Kasper G. Lauridsen1Kasper Adelborg2Peter Torp3Leif F. Bach4Simon M. Jepsen5Nete Hornung6Charles D. Deakin7Hans Rickers8Bo Løfgren9Clinical Research Unit Regional Hospital of Randers Randers NE DenmarkClinical Research Unit Regional Hospital of Randers Randers NE DenmarkDepartment of Internal Medicine Regional Hospital of Randers Randers NE DenmarkDepartment of Internal Medicine Regional Hospital of Randers Randers NE DenmarkDepartment of Anesthesiology Regional Hospital of Randers Randers NE DenmarkDepartment of Anesthesiology Regional Hospital of Randers Randers NE DenmarkDepartment of Clinical Biochemistry Regional Hospital of Randers Randers NE DenmarkNIHR Southampton Respiratory Biomedical Research Unit University Hospital Southampton NHS Foundation Trust Southampton United KingdomDepartment of Internal Medicine Regional Hospital of Randers Randers NE DenmarkDepartment of Internal Medicine Regional Hospital of Randers Randers NE DenmarkBackground Several different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB shocks with biphasic truncated exponential (BTE) shocks in patients undergoing cardioversion of atrial fibrillation or ‐flutter. Methods and Results This prospective, randomized study included patients admitted for elective direct current cardioversion. Patients were randomized to receive cardioversion using either PB or BTE shocks. We used escalating shocks until sinus rhythm was obtained or to a maximum of 4 shocks. Patients randomized to PB shocks received 90, 120, 150, and 200 J and patients randomized to BTE shocks received 100, 150, 200, and 250 J, as recommended by the manufacturers. In total, 69 patients (51%) received PB shocks and 65 patients (49%) BTE shocks. Successful cardioversion, defined as sinus rhythm 4 hours after cardioversion, was achieved in 43 patients (62%) using PB shocks and in 56 patients (86%) using BTE shocks; ratio 1.4 (95% CI 1.1–1.7) (P=0.002). There was no difference in safety (ie, myocardial injury judged by changes in high‐sensitive troponin I levels; ratio 1.1) (95% CI 1.0–1.3), P=0.15. The study was terminated prematurely because of an adverse event. Conclusions Cardioversion using a BTE waveform was more effective when compared with a PB waveform. There was no difference in safety between the 2 waveforms, as judged by changes in troponin I levels. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02317029.https://www.ahajournals.org/doi/10.1161/JAHA.116.004853atrial fibrillationbiphasic waveformscardioversion |
| spellingShingle | Anders S. Schmidt Kasper G. Lauridsen Kasper Adelborg Peter Torp Leif F. Bach Simon M. Jepsen Nete Hornung Charles D. Deakin Hans Rickers Bo Løfgren Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation biphasic waveforms cardioversion |
| title | Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial |
| title_full | Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial |
| title_fullStr | Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial |
| title_full_unstemmed | Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial |
| title_short | Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial |
| title_sort | cardioversion efficacy using pulsed biphasic or biphasic truncated exponential waveforms a randomized clinical trial |
| topic | atrial fibrillation biphasic waveforms cardioversion |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.004853 |
| work_keys_str_mv | AT anderssschmidt cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT kasperglauridsen cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT kasperadelborg cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT petertorp cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT leiffbach cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT simonmjepsen cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT netehornung cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT charlesddeakin cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT hansrickers cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial AT boløfgren cardioversionefficacyusingpulsedbiphasicorbiphasictruncatedexponentialwaveformsarandomizedclinicaltrial |