Defibrillation Efficacy and Pain Perception of Two Biphasic Waveforms for Internal Cardioversion of Atrial Fibrillation

Introduction: We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500‐μF capacitor with 40% tilt was compared to a standard biphasic wave...

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Bibliographic Details
Published in:Journal of cardiovascular electrophysiology 2003-08, Vol.14 (8), p.837-840
Main Authors: Jung, Jens, Siaplaouras, Stephanos, Buob, Axel, Schubert, Bernd D., Hahn, Stephen J., Heisel, Armin
Format: Article
Language:English
Subjects:
atrial defibrillation threshold
Atrial Fibrillation - complications
Atrial Fibrillation - therapy
Defibrillators, Implantable - adverse effects
Electric Countershock - adverse effects
Electric Countershock - methods
Female
Humans
internal cardioversion
Male
Middle Aged
Pain - etiology
Pain - prevention & control
Pain Measurement
pain perception
peak voltage
shock waveform
Treatment Outcome
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Summary:Introduction: We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500‐μF capacitor with 40% tilt was compared to a standard biphasic waveform generated by a 60‐μF capacitor with 80% tilt. Methods and Results: In 19 patients with paroxysmal atrial fibrillation (79% male, age 55 ± 11 years, 21% with heart disease), the atrial defibrillation threshold (ADFT) was determined during deep sedation with midazolam for both waveforms in a randomized fashion using a step‐up protocol. Internal cardioversion with a single lead (shock vector: coronary sinus to right atrium) was successful in 18 (95%) of 19 patients. ADFT energy and peak voltage were significantly lower for the low‐voltage waveform (2.1 ± 2.4 J vs 3.5 ± 3.9 J, P < 0.01; 100 ± 53 V vs 290 ± 149 V, P < 0.01). Sedation then was reversed with flumazenil after ADFT testing. Two shocks at the ADFT (or a 3‐J shock if ADFT >3 J) were administered to the patient using each waveform in random order. Pain perception was assessed using both a visual scale and a numerical score. ADFTs were above the pain threshold in 17 (94%) of 18 patients, even though the ADFT with the 500‐μF waveform was
ISSN:1045-3873
1540-8167
DOI:10.1046/j.1540-8167.2003.02557.x