Ventricular defibrillation using biphasic waveforms: The importance of phasic duration

AbstractBiphasic waveforms can be used to defibrillate the heart with less energy than that used by monophasic waveforms. In 14 anesthetized open chest dogs with large contoured defibrillation electrodes, the effect on defibrillation efficacy of varying the duration of the two phases of biphasic waveforms was studied. All combinations of 0, 1, 3.5, 6 and 8.5 ms duration were used for both the first and the second phase except for the meaningless case in which both durations were 0 ms. The 3.5-2 waveform (3.5 ms first phase and 2 ms second phase) was also tested.All the hearts were defibrillated with ⪯5 joules using any of the 25 waveforms. However, biphasic waveforms with the second phase shorter than or equal to the first had significantly lower defibrillation thresholds than did those with the second phase longer than the first or than did monophasic waveforms of approximately the same total duration. A plot of defibrillation threshold current strength versus second phase duration for all biphasic waveforms with a 3.5 ms first phase did not produce a hyperbolic strength-duration curve as seen with monophasic waveforms. To verify these findings, defibrillation dose-response curves were obtained for the 3.5-2, 6-6 and 3.5–8.5 biphasic waveforms in another six dogs. The 50 and 80% successful voltage doses of the 3.5–8.5 waveforms were significantly higher than those of the other two waveforms, which were not different from one another.In conclusion: 1) phasic durations of biphasic waveforms are important determinants of defibrillation efficacy and biphasic waveforms with the second phase shorter than the first are more effective than are those with the reverse sequence; 2) the strength-duration relation for the defibrillation threshold is different for biphasic and monophasic waveforms; 3) defibrillation of the canine heart can be achieved with low energy with use of large contoured pericardial electrodes and suitable biphasic waveforms