Optimized first phase tilt in "parallel-series" biphasic waveform.
BACKGROUND
A biphasic defibrillation waveform can achieve a large second phase leading-edge voltage by a "parallel-series" switching system. Recently, such a system using two 30-microF capacitances demonstrated better defibrillation threshold than standard waveforms available in current implantable devices. However, the optimized tilt of such a "parallel-series" system had not been defined.


RESULTS
Defibrillation thresholds were evaluated for five different biphasic "parallel-series" waveforms (60/15 microF) and a biphasic "parallel-parallel" waveform (60/60 microF) in 12 anesthetized pigs. The five "parallel-series" waveforms had first phase tilts of 40%, 50%, 60%, 70%, and 80% with second phase pulse width of 3 msec. The "parallel-parallel" waveform had first phase tilt of 50% with second phase pulse width of 3 msec. The defibrillation lead system comprised a left pectoral "hot can" electrode (cathode) and a right ventricular lead (anode). The stored energy at defibrillation threshold of the "parallel-series" waveform with first phase tilts of 40%, 50%, 60%, 70%, and 80% was 7.0 +/- 2.1, 6.1 +/- 2.8, 6.8 +/- 2.8, 7.2 +/- 2.9, and 8.4 +/- 3.1 J, respectively. The stored energy of the "parallel-series" waveform with a 50% first phase tilt was 16% less than the nonswitching "parallel-parallel" waveform (7.3 +/- 2.8 J, P = 0.006).


CONCLUSIONS
A first phase tilt of 50% maximized defibrillation efficacy of biphasic waveforms implemented with a "parallel-series" switching system. This optimized "parallel-series" waveform was more efficient than the comparable "parallel-parallel" biphasic waveform having the same first phase capacitance and tilt.
Yamanouchi
Y
Y
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Mowrey
K A
KA
Kroll
M W
MW
Brewer
J E
JE
Donohoo
A M
AM
Wilkoff
B L
BL
Tchou
P J
PJ
D000818:Animals; D017147:Defibrillators, Implantable; D004553:Electric Conductivity; D004554:Electric Countershock / Q000379:methods*; D013552:Swine