Efficacy of biphasic waveform cardioversion for atrial fibrillation and atrial flutter compared with conventional monophasic waveforms

Abstract

Based on extensive experience with implantable cardioverter-defibrillators and automatic external defibrillators, the utility of biphasic transthoracic shock has been demonstrated in the setting of life-threatening ventricular tachyarrhythmias. 1 Bardy G.H. Ivey T.D. Allen M.D. Johnson G. Mehra R. Greene H.L. A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans. J Am Coll Cardiol. 1989; 14: 728-733 Abstract Full Text PDF PubMed Scopus (196) Google Scholar , 2 Saksena S. An H. Mehra R. DeGroot P. Krol R.B. Burkhardt E. Mehta D. John T. Prospective comparison of biphasic and monophasic shocks for implantable cardioverter-defibrillators using endocardial leads. Am J Cardiol. 1992; 70: 304-310 Abstract Full Text PDF PubMed Scopus (76) Google Scholar , 3 Wyse D.G. Kavanaugh K.M. Gillis A.M. Mitchell L.B. Duff H.J. Sheldon R.S. Kieser T.M. Maitland A. Flanagan P. Rothschild J. Mehra R. Comparison of biphasic and monophasic shocks for defibrillation using a nonthoracotomy system. Am J Cardiol. 1993; 71: 197-202 Abstract Full Text PDF PubMed Scopus (81) Google Scholar These observations have led to the application of biphasic waveforms during elective transthoracic cardioversion for atrial fibrillation (AF). 4 Benditt D.G. Samniah N. Iskos D. Lurie K.G. Padanilam B.J. Sakaguchi S. Biphasic waveform cardioversion as an alternative to internal cardioversion for atrial fibrillation refractory to conventional monophasic waveform transthoracic shock. Am J Cardiol. 2001; 88: 1426-1428 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The present report compares cardioversion outcomes in 2 sequential groups of patients with AF undergoing transthoracic cardioversion. It was undertaken in an attempt to ascertain the extent to which biphasic waveform technique enhances transthoracic AF cardioversion success rates.