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Comparison of Fixed Tilt and Tuned Defibrillation Waveforms: The PROMISE Study
Author(s) -
GOLD MICHAEL R.,
VALMEJIAS JESUS,
CUOCO FRANK,
SIDDIQUI MUKKARAM
Publication year - 2013
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12041
Subject(s) - defibrillation , waveform , medicine , tilt (camera) , defibrillation threshold , electric shock , electrical impedance , voltage , acoustics , cardiology , electrical engineering , physics , mathematics , geometry , engineering
Comparison of Defibrillation Waveforms . Background: All modern defibrillation systems use biphasic shock waveforms. Typically a fixed tilt waveform is used for implantable defibrillators (ICDs), but a tuned waveform with duration based on shock impedance may be superior based on theoretical calculations.Objective:The objective of this study was to compare defibrillation efficacy of fixed tilt and tuned waveforms.Methods:PROMISE was designed as a prospective, within‐patient, randomized study of defibrillation thresholds (DFTs) comparing a tuned (assuming a 3.5 milliseconds membrane time constant) versus a 50/50% tilt waveform. All patients had a left pectoral implant (active can) and testing was performed with a single coil shocking configuration (“SVC coil OFF”). DFTs were measured in random order with a binary search method in 52 patients, using the high‐voltage lead impedance to select the pulse widths for both waveforms.Results:At the DFT, the tuned waveform had similar delivered energy (10.5 ± 6.3 vs 9.5 ± 5.5 J, P = 0.47), stored energy (13.6 ± 7.9 vs 11.3 ± 6.3 J, P = 0.06), peak current (7.5 ± 3.0 vs 6.8 ± 2.2 A, P = 0.09), and delivered voltage (451.0 ± 134.5 vs 411.5 ± 120.7 V, P = 0.05) compared with the 50/50% tilt waveform.Conclusion:The DFTs for 3.5‐millisecond time constant based tuned and 50/50% tilt waveforms are similar using a single coil, left pectoral active can. (J Cardiovasc Electrophysiol, Vol. 24, pp. 323‐327, March 2013)