14739730

Source:http://linkedlifedata.com/resource/pubmed/id/14739730

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Predicate	Object
rdf:type	pubmed:Citation
lifeskim:mentions	umls-concept:C0004238, umls-concept:C0036974, umls-concept:C0205184, umls-concept:C0205186, umls-concept:C0439836
pubmed:issue	3
pubmed:dateCreated	2004-1-23
pubmed:abstractText	Cardioversion of atrial fibrillation (AF) using traditional monophasic shock waveform is unsuccessful in up to 20% of cases, and often requires several shocks of up to 360 J. Based on the success with biphasic shock waveform in converting ventricular fibrillation, it was postulated that biphasic shocks would allow cardioversion with lower energy. In a international multicenter, double-blind, randomized trial of 203 patients, damped sine wave monophasic shocks were compared with impedance-compensated truncated exponential biphasic waveform shocks. Patients received up to five shocks: 100 J, 150 J, 200 J, a fourth shock at maximum output for the initial waveform (200 J biphasic, 360 J monophasic) and a final cross-over shock at maximum output of the alternate waveform. For each energy level, the biphasic waveform compared favorably to the monophasic waveform in successful cardioversion (100 J: 60% versus 22%, P < 0.0001; 150 J: 77% versus 44%, p < 0.0001; 200 J: 90% versus 53%, p < 0.0001). Success with 200 J biphasic was equivalent to 360 J monophasic shock (91% versus 85%, p = 0.29). Patients randomized to biphasic waveform required fewer shocks and lower total energy delivered; in addition, this waveform was associated with less dermal injury and no blistering. Biphasic shocks converted AF present for less than 48 hours with 80% efficacy, but conversion of AF present for more than 48 hours and more than 1 year the success rate was only 63 and 20%, respectively. The results of this study is similar to other investigations comparing biphasic and monophasic shock waveforms for conversion of atrial fibrillation. We recommend starting with biphasic energy of 100 J for atrial fibrillation of less than 48 hours duration, but using higher energies (150 J, 200 J or greater) when AF has been present for longer periods.
pubmed:language	eng
pubmed:journal	http://linkedlifedata.com/resource/pubmed/journal/9708907
pubmed:citationSubset	IM
pubmed:status	MEDLINE
pubmed:month	Sep
pubmed:issn	1385-2264
pubmed:author	pubmed-author:PageRichard LRL, pubmed-author:RhoRobert WRW
pubmed:issnType	Print
pubmed:volume	7
pubmed:owner	NLM
pubmed:authorsComplete	Y
pubmed:pagination	290-1
pubmed:dateRevised	2007-11-15
pubmed:meshHeading	pubmed-meshheading:14739730-Atrial Fibrillation, pubmed-meshheading:14739730-Electric Countershock, pubmed-meshheading:14739730-Humans, pubmed-meshheading:14739730-Randomized Controlled Trials as Topic, pubmed-meshheading:14739730-Treatment Outcome
pubmed:year	2003
pubmed:articleTitle	Biphasic versus monophasic shock waveform for conversion of atrial fibrillation.
pubmed:affiliation	The University of Washington School of Medicine, Seattle, WA 98195-6422, USA. rrho@u.washington.edu
pubmed:publicationType	Journal Article, Clinical Trial, Comparative Study, Randomized Controlled Trial