title: Multicenter comparison of truncated biphasic shocks and standard damped sine wave monophasic shocks for transthoracic ventricular defibrillation. Transthoracic Investigators.
abstract: BACKGROUND
  The most important factor for improving out-of-hospital ventricular fibrillation survival rates is early defibrillation. This can be achieved if small, lightweight, inexpensive automatic external defibrillators are widely disseminated. Because automatic external defibrillator size and cost are directly affected by defibrillation waveform shape and because of the favorable experience with truncated biphasic waveforms in implantable cardioverter-defibrillators, we compared the efficacy of a truncated biphasic waveform with that of a standard damped sine monophasic waveform for transthoracic defibrillation.
  
  
  RESULTS
  The principal goal of this multicenter, prospective, randomized, blinded study was to compare the first-shock transthoracic defibrillation efficacy of a 130-J truncated biphasic waveform with that of a standard 200-J monophasic damped sine wave pulse using anterior thoracic pads in the course of implantable cardioverter-defibrillator testing. Pad-pad ECGs were also examined after transthoracic defibrillation. After the elimination of data for 24 patients who did not meet all protocol criteria, the results from 294 patients were analyzed. The 130-J truncated biphasic pulse and the 200-J damped sine wave monophasic pulse resulted in first-shock efficacy rates of 86% and 86%, respectively (P = .97). ST-segment levels measured 10 seconds after the shock in 151 patients in sinus rhythm were -0.26 +/- 1.58 and -1.86 +/- 1.93 mm for the 130- and 200-J shocks, respectively (P < .0001).
  
  
  CONCLUSIONS
  We found that 130-J biphasic truncated transthoracic shocks defibrillate as well as the 200-J monophasic damped sine wave shocks that are traditionally used in standard transthoracic defibrillators and result in fewer ECG abnormalities after the shock.
authors.affiliation: Department of Medicine, University of Washington (Seattle), USA. gbardy@u.washington.edu
authors.forename: G H
authors.initials: GH
authors.lastname: Bardy
authors.forename: F E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: A D
authors.initials: AD
authors.lastname: Sharma
authors.forename: S J
authors.initials: SJ
authors.lastname: Worley
authors.forename: R M
authors.initials: RM
authors.lastname: Luceri
authors.forename: R
authors.initials: R
authors.lastname: Yee
authors.forename: B D
authors.initials: BD
authors.lastname: Halperin
authors.forename: C L
authors.initials: CL
authors.lastname: Fellows
authors.forename: T S
authors.initials: TS
authors.lastname: Ahern
authors.forename: D A
authors.initials: DA
authors.lastname: Chilson
authors.forename: D L
authors.initials: DL
authors.lastname: Packer
authors.forename: D J
authors.initials: DJ
authors.lastname: Wilber
authors.forename: T A
authors.initials: TA
authors.lastname: Mattioni
authors.forename: R
authors.initials: R
authors.lastname: Reddy
authors.forename: R A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: R
authors.initials: R
authors.lastname: Lazzara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*