Prospective randomized comparison of anodal monophasic shocks versus biphasic cathodal shocks on defibrillation energy requirements

American Heart Journal
S A StrickbergerF Morady

Abstract

Biphasic shocks are believed to be superior to monophasic shocks. Monophasic anodal shocks, as opposed to cathodal shocks, are associated with improved defibrillation energy requirements (DERs). However, it is unclear how the DER of anodal monophasic shocks compare with conventional biphasic shocks. Therefore the purpose of this study was to prospectively compare the DER of an anodal monophasic shock with that of a cathodal biphasic shock. A transvenous defibrillation lead with distal and proximal shocking electrodes was used. The subjects of this study were 20 consecutive patients with a mean age of 64.2 +/- 10.5 years ( +/- SD) and a mean left ventricular ejection fraction of 0.36 +/- 0.18. Six had had cardiac arrest. The DER, defined as the lowest energy that converted ventricular fibrillation to sinus rhythm, was determined twice with a step-down protocol (25 J, 20 J, 15 J, 10 J, 5 J, 3 J, 1 J). If the DER was > or = 25 J, then a subcutaneous patch was deemed necessary for system implantation. In random order the DER was determined with a monophasic anodal shock (distal electrode positive) and then with a cathodal (first phase, distal electrode negative) biphasic shock. The mean DER with anodal monophasic shocks was 15.1 +/...Continue Reading

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Citations

Jun 2, 2007·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Mark W Kroll, Charles D Swerdlow
Aug 23, 2006·Pacing and Clinical Electrophysiology : PACE·Mark W KrollPatrick J Tchou
Feb 26, 2016·The Cochrane Database of Systematic Reviews·Steven C Faddy, Paul A Jennings
May 8, 2018·Current Cardiology Reports·Marye J GlevaJeanne Poole

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