Mortensen Kai, Risius Tim, Schwemer Tjark F, Aydin Muhammet Ali, Köster Ralf, Klemm Hanno U, Lutomsky Boris, Meinertz Thomas, Ventura Rodolfo, Willems Stephan
Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Cardiology. 2008;111(1):57-62. doi: 10.1159/000113429. Epub 2008 Feb 1.
External cardioversion is effective to terminate persistent atrial flutter. Biphasic shocks have been shown to be superior to monophasic shocks for ventricular defibrillation and atrial fibrillation cardioversion. The purpose of this trial was to compare the efficacy of rectilinear biphasic versus standard damped sine wave monophasic shocks in symptomatic patients with typical atrial flutter.
135 consecutive patients were screened, 95 (70 males, mean age 62 +/- 13 years) were included. Patients were randomly assigned to a monophasic or biphasic cardioversion protocol. Forty-seven patients randomized to the monophasic protocol received sequential shocks of 100, 150, 200, 300 and 360 J. Forty-eight patients with the biphasic protocol received 50, 75, 100, 150 or 200 J.
First-shock efficacy with 50-Joule, biphasic shocks (23/48 patients, 48%) was significantly greater than with the 100-Joule, monophasic waveform (13/47 patients, 28%, p = 0.04). The cumulative second-shock efficacy with the 50- and 75-Joule, biphasic waveform (39/48 patients, 81%) was significantly greater than with the 100- and 150-Joule, monophasic waveform (25/47 patients, 53%, p < 0.05). The cumulative efficacy for the higher energy levels showed naturally no significant difference between the two groups. The amount of the mean delivered energy was significantly lower in the biphasic group (76 +/- 39 J) compared to the monophasic one (177 +/- 78 J, p < 0.05).
For transthoracic cardioversion of typical atrial flutter, biphasic shocks have greater efficacy and the mean delivered current is lower than for monophasic shocks. Therefore, biphasic cardioversion with lower starting energies should be recommended.
体外心脏复律对于终止持续性心房扑动有效。双相电击已被证明在心室除颤和心房颤动复律方面优于单相电击。本试验的目的是比较直线双相电击与标准衰减正弦波单相电击对有症状的典型心房扑动患者的疗效。
连续筛查135例患者，纳入95例（70例男性，平均年龄62±13岁）。患者被随机分配到单相或双相复律方案。随机分配到单相方案的47例患者接受100、150、200、300和360焦耳的连续电击。采用双相方案的48例患者接受50、75、100、150或200焦耳电击。
50焦耳双相电击的首次电击成功率（23/48例患者，48%）显著高于100焦耳单相波形电击（13/47例患者，28%，p = 0.04）。50和75焦耳双相波形电击的累计二次电击成功率（39/48例患者，81%）显著高于100和150焦耳单相波形电击（25/47例患者，53%，p < 0.05）。两组在更高能量水平下的累计成功率自然无显著差异。双相组的平均输送能量（76±39焦耳）显著低于单相组（177±78焦耳，p < 0.05）。
对于典型心房扑动的经胸心脏复律，双相电击比单相电击疗效更好，且平均输送电流更低。因此，建议采用起始能量较低的双相心脏复律。
