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Clinical Trial
. 2004 May;147(5):e20.
doi: 10.1016/j.ahj.2003.10.049.

A randomized trial comparing monophasic and biphasic waveform shocks for external cardioversion of atrial fibrillation

Rudolph W Koster  1 , Paul Dorian, Fred W Chapman, Paul W Schmitt, Sharon G O'Grady, Robert G Walker
Affiliations
Clinical Trial

A randomized trial comparing monophasic and biphasic waveform shocks for external cardioversion of atrial fibrillation

Rudolph W Koster et al. Am Heart J. 2004 May.

Abstract

Background: We compared efficacy of and pain felt after biphasic truncated exponential (BTE) and monophasic damped sine (MDS) shocks in patients undergoing external cardioversion of atrial fibrillation (AF).

Methods: Patients with AF were randomized to BTE or MDS waveform cardioversion. Successive shocks were delivered at 70, 100, 200, and 360 J until successful cardioversion, with one 360 J attempt of the alternate waveform when all 4 shocks failed. Success was determined by blinded over-read of electrocardiograms. Peak current was calculated from energy and impedance. Patients rated their pain at 1 and 24 hours after cardioversion.

Results: Fourteen of 37 (38%) patients treated with MDS and 34 of 35 (97%) treated with BTE shocks were cardioverted at < or =200 J (P <.0001). Success rates of MDS versus BTE shocks were 5.4% versus 60% for 70 J, 19% versus 80% for < or =100 J, and 86% versus 97% for < or =360 J. BTE shocks cardioverted with less peak current (14.0 +/- 4.3 vs 39.5 +/- 11.2 A, P <.0001), less energy (97 +/- 47 vs 278 +/- 120 J, P <.0001), and less cumulative energy (146 +/- 116 vs 546 +/- 265 J, P <.0001). Patients felt less pain after BTE than MDS shocks at 1 hour (P <.0001) and 24 hours (P <.0001) after cardioversion.

Conclusion: This BTE waveform is superior to the MDS waveform for cardioversion of AF, requiring much less energy and current, and causing less postprocedural pain.

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