PMID: 9160225May 1, 1997Paper

Effect of waveform tilt on defibrillation thresholds in humans

Journal of Cardiovascular Electrophysiology
S R ShorofskyMichael R Gold

Abstract

Despite the common use of the implantable cardioverter defibrillator to treat patients with life-threatening ventricular arrhythmias, the mechanism of defibrillation and the optimal waveform for implanted devices are poorly understood. All of the currently available pulse generators deliver exponentially declining pulses that are either automatically or manually truncated to achieve tilts of about 50% to 65%. Although this value was chosen based on experimental animal data, several theoretical models have been developed to describe defibrillation, which raise into question this choice of waveform shape. Accordingly, the present study was designed to test the effect of waveform tilt on defibrillation efficacy in humans. Twenty-three patients undergoing cardioverter defibrillator implantation were studied. Monophasic defibrillation thresholds (DFTs) were measured using a single reversal protocol at 35%, 50%, 65%, and 80% tilts by altering the pulse width of the shock. Mean defibrillation impedance was 41 +/- 6 omega. The DFT, measured by either leading-edge voltage or stored energy, was insensitive to altering the waveform tilt from 50% to 80%, only increasing when the tilt was reduced to 35%. A tilt of 65% yielded the lowest DFT...Continue Reading

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Citations

Aug 25, 1999·Annals of Emergency Medicine·J B WhiteR E Ideker
Jan 5, 2001·Pacing and Clinical Electrophysiology : PACE·G MouchawarZ Syed
Jan 25, 2011·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Carl R Reynolds, Michael R Gold
Dec 17, 2003·Pacing and Clinical Electrophysiology : PACE·Yoshio YamanouchiPatrick J Tchou
Mar 29, 2007·Journal of Cardiovascular Electrophysiology·Liang TangShien-Fong Lin
Dec 6, 2012·Journal of Cardiovascular Electrophysiology·Michael R GoldMukkaram Siddiqui
Dec 13, 1997·Circulation·M R Gold, S R Shorofsky
May 6, 2006·Journal of Biomedical Optics·Krishna RaviShien-Fong Lin
Dec 28, 2018·Arrhythmia & Electrophysiology Review·Justin HayaseNoel G Boyle
Aug 25, 2021·Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine·Mathias DavidsLawrence L Wald

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