The Defibrillation Waveform

  • Susan M. Blanchard
  • Raymond E. Ideker
  • Randolph A. S. Cooper
  • J. Marcus Wharton
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 188)


THE EFFICACY of the shock used for internal defibrillation depends upon the shape of the defibrillation waveform as well as the placement of the defibrillation electrodes and the sequence in which shocks are delivered. The waveform shape also has a direct bearing on the lifetime of the battery used in an ICD since battery and capacitor size are the main determinants in the development of small, efficient devices.1 Much work is being done to diminish the energy requirements for defibrillation without reducing the effectiveness of the ICD by using more effective waveforms. Reducing the energy required for defibrillation could also lead to fewer instances of adverse effects, such as conduction disturbance,2 ventricular dysfunction,3 and myocardial necrosis,4,5 which occur when myocardium is exposed to high energy shocks.


Defibrillation Threshold Biphasic Waveform Ventricular Defibrillation Monophasic Waveform Defibrillation Efficacy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Troup PJ. Implantable cardioverters and defibrillators. Curr Probl Cardiol 1989;14:675–843.CrossRefGoogle Scholar
  2. 2.
    Yabe S, Smith WM, Daubert JP, et al. Conduction disturbances caused by high current density electric fields. Circ Res 1990;66:1190–1203.PubMedCrossRefGoogle Scholar
  3. 3.
    Lerman BB, Weiss JL, Bulkley BH, et al. Myocardial injury and induction of arrhythmia by direct current shock delivered via endocardial catheters in dogs. Circulation 1984;69:1006–1012.PubMedCrossRefGoogle Scholar
  4. 4.
    Jones JL, Lepeschkin E, Jones RE, et al. Response of cultured myocardial cells to countershock-type electric field stimulation. Am J Physiol 1978;235:H214-H222.Google Scholar
  5. 5.
    Doherty PW, McLaughlin PR, Billingham M, et al. Cardiac damage produced by direct current countershock applied to the heart. Am J Cardiol 1979;43:225–232.PubMedCrossRefGoogle Scholar
  6. 6.
    Hooker DR, Kouwenhoven WB, Langworthy OR. The effect of alternating currents on the heart. Am J Physiol 1933;103:444–454.Google Scholar
  7. 7.
    Beck CS, Pritchard WH, Feil HS. Ventricular fibrillation of long duration abolished by electric shock. JAMA 1947;135:985–986.CrossRefGoogle Scholar
  8. 8.
    Zoll PM, Linenthal AJ, Gibson W, et al. Termination of ventricular fibrillation in man by externally applied electric countershock. N Engl J Med 1956;254:727–732.PubMedCrossRefGoogle Scholar
  9. 9.
    Lown B, Newman J, Amarasingham R, et al. Comparison of alternating current with direct current electroshock across the closed chest. Am J Cardiol 1962;10:223–233.PubMedCrossRefGoogle Scholar
  10. 10.
    Gurvich NL, Yuniev GS. Restoration of regular rhythm in the mammalian fibrillating heart. Bulletin of Experimental Biology in Medicine 1939;8:55–58.Google Scholar
  11. 11.
    Pelèsta B. Optimal parameters of electrical impulses for defibrillation by condenser discharges. Circ Res 1966;18:10–17.CrossRefGoogle Scholar
  12. 12.
    Geddes LA, Tacker WA. Engineering and physiological considerations of direct capacitor-discharge ventricular defibrillation. Med Biol Eng 1971;9:185–199.PubMedCrossRefGoogle Scholar
  13. 13.
    Scnuder JC, Stoeckle H, Keskar PY, et al. Transthoracic ventricular defibrillation in the dog with unidirectional rectangular double pulses. Cardiovasc Res 1970;4:497–501.CrossRefGoogle Scholar
  14. 14.
    Koning G, Schneiger H, Hoelen AJ. Amplitude-duration relation for direct ventricular defibrillation with rectangular current pulses. Med Biol Eng 1975;13:388–395.PubMedCrossRefGoogle Scholar
  15. 15.
    Bourland JD, Tacker WA, Geddes LA. Strength-duration curves for trapezoidal waveforms of various tilts for transchest defibrillation in animals. Med Instrum 1978;12:38–41.PubMedGoogle Scholar
  16. 16.
    Block M, Breithardt G. Optimizing defibrillation through improved waveforms. PACE 1995;18:526–538.PubMedCrossRefGoogle Scholar
  17. 17.
    Schuder JC, Stoeckle H, Gold JH, et al. Experimental ventricular defibrillation with an automatic and completely implanted system. Trans Am Soc Artif Intern Organs 1970;16:207–212.PubMedGoogle Scholar
  18. 18.
    Mirowski M, Mower MM, Reid PR, et al. The automatic implantable defibrillator. PACE 1982;5:384–401.PubMedCrossRefGoogle Scholar
  19. 19.
    Wessale JL, Bourland JD, Tacker WA, et al. Bipolar catheter defibrillation in dogs using trapezoidal waveforms of various tilts. J Electrocard 1980;13:359–366.CrossRefGoogle Scholar
  20. 20.
    Kroll MW. A minimal model of the monophasic defibrillation pulse. PACE 1993;16:769–777.PubMedCrossRefGoogle Scholar
  21. 21.
    Chapman PD, Wetherbee JN, Vetter JW, et al. Strength-duration curves of fixed pulse width variable tilt truncated exponential waveforms for nonthoracotomy internal defibrillation in dogs. PACE 1988;11:1045–1050.PubMedCrossRefGoogle Scholar
  22. 22.
    Tacker WA, Geddes LA. The automatic implantable defibrillator (AID). In: Electrical Defibrillation. Boca Raton. Florida: CRC Press, Inc., 1980 pp 167–178.Google Scholar
  23. 23.
    Orias O. Possible mecanismo de 1a defibrilación miocárdica por contrachoque eléctrico. Acta Physiol Pharmacol Lationam 1953;3:147–150.Google Scholar
  24. 24.
    Sweeney RJ, Gill KM, Reid PR. Characterization of refractory period extension by transcardiac shock. Circulation 1991;83:2057–2066.PubMedCrossRefGoogle Scholar
  25. 25.
    Bourland JD, Tacker WA, Wessale JL, et al. Sequential pulse defibrillation for implantable defibrillators. Med Instrum 1986;20:138–142.PubMedGoogle Scholar
  26. 26.
    Jones DL, Klein GJ, Guiradon GM, et al. Internal cardiac defibrillation in man: Pronounced improvement with sequential pulse delivery to two different lead orientations. Circulation 1986;73:484–491.PubMedCrossRefGoogle Scholar
  27. 27.
    Jones DL, Klein GJ, Guiradon GM, et al. Prediction of defibrillation success from a single defibrillation threshold measurement with sequential pulses and two current pathways in humans. Circulation 1988;78:1144–1149.PubMedCrossRefGoogle Scholar
  28. 28.
    Bardou AL, Degonde J, Birkui PJ, et al. Reduction of energy required for defibrillation by delivering shocks in orthogonal directions in the dog. PACE 1988;11:1990–1995.PubMedCrossRefGoogle Scholar
  29. 29.
    Jones DL, Klein GJ, Kallok MJ. Improved internal defibrillation with twin pulse sequential energy delivery to different lead orientations. Am J Cardiol 1985;55:821–825.PubMedCrossRefGoogle Scholar
  30. 30.
    Jones DL, Sohla A, Bourland JD, et al. Internal ventricular defibrillation with sequential pulse countershock in pigs: Comparison with single pulses and effects of pulse separation. PACE 1987;10:497–502.PubMedCrossRefGoogle Scholar
  31. 31.
    Gurvich NL, Markarychev VA. Defibrillation of the heart with biphasic electrical impulses. Kardiologilia 1967;7:109–112.Google Scholar
  32. 32.
    Schuder JC, McDaniel WC, Stoeckle H. Defibrillation of 100-kg calves with asymmetrical, bidirectional, rectangular pulses. Cardiovasc Res 1984;18:419–426.PubMedCrossRefGoogle Scholar
  33. 33.
    Dixon EG, Tang ASL, Wolf PD, et al. Improved defibrillation thresholds with large contoured epicardial electrodes and biphasic waveforms. Circulation 1987;76:1176–1184.PubMedCrossRefGoogle Scholar
  34. 34.
    Holley LK, McCulloch RM. Comparison of biphasic and monophasic defibrillation waveforms in an isolated rabbit heart preparation. Cardiovasc Res 1991;25:979–983.PubMedCrossRefGoogle Scholar
  35. 35.
    Tang ASL, Yabe S, Wharton JM, et al. Ventricular defibrillation using biphasic waveforms: The importance of phasic duration. J Am Coll Cardiol 1989;13:207–214.PubMedCrossRefGoogle Scholar
  36. 36.
    Cooper RAS, Guse PA, Dixon-Tulloch EG, et al. The effect of phase separation on biphasic waveform defibrillation. PACE 1991;14:667. (abstract)Google Scholar
  37. 37.
    Kavanagh KM, Tang ASL, Rollins DL, et al. Comparison of the internal defibrillation thresholds for monophasic and double and single capacitor biphasic waveforms. J Am Coll Cardiol 1989;14:1343–1349.PubMedCrossRefGoogle Scholar
  38. 38.
    Bardy GH, Ivey TD, Allen MD, et al. A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans. J Am Coll Cardiol 1989;14:728–733.PubMedCrossRefGoogle Scholar
  39. 39.
    Winkle RA, Mead RH, Ruder MA, et al. Improved low energy defibrillation efficacy in man with the use of a biphasic truncated exponential waveform. Am Heart J 1989;117:122–127.PubMedCrossRefGoogle Scholar
  40. 40.
    Dutinth V, Schwartzman D, Callans DJ, et al. Defibrillation thresholds with monophasic versus biphasic shocks delivered through a single-lead endocardial defibrillation system. Am Heart J 1996;131:611–613.PubMedCrossRefGoogle Scholar
  41. 41.
    Guse PA, Walcott GP, Rollins DL, et al. Defibrillation electrode configurations developed from cardiac mapping that combine biphasic shocks with sequential timing. Am Heart J 1992;124:1491–1500.PubMedCrossRefGoogle Scholar
  42. 42.
    Jones DL, Klein GJ, Wood GK. Biphasic versus sequential pulse defibrillation: A direct comparison in pigs. Am Heart J 1992;124:97–103.PubMedCrossRefGoogle Scholar
  43. 43.
    Johnson EE, Walcott GP, Melnick S, et al. Defibrillation efficacy for various delays between two successive biphasic shocks. PACE 1991;14:715. (abstract)Google Scholar
  44. 44.
    Saksena S, An H, Mehra R, DeGroot P, et al. Prospective comparison of biphasic and monophasic shocks for implantable cardioverter-defibrillators using endocardial leads. Am J Cardiol 1992;70:304–310.PubMedCrossRefGoogle Scholar
  45. 45.
    Cranefield PF, Hoffman BF. Propagated repolarization in heart muscle. J Gen Physiol 1958;41:633–649.PubMedCrossRefGoogle Scholar
  46. 46.
    Jones JL, Jones RE, Balasky G. Improved cardiac cell excitation with symmetrical biphasic defibrillator waveforms. Am J Physiol 1987;253:H1418-H1424.Google Scholar
  47. 47.
    Ideker RE, Tang ASL, Frazier DW, et al. Ventricular defibrillation: Basic concepts. In El-Sherif N, Samet P, (eds) Cardiac Pacing and Electrophysiology. Orlando, Florida: W. B. Saunders Co., 1991 pp 713–726.Google Scholar
  48. 48.
    Zhou X, Daubert JP, Wolf PD, et al. Epicaraial mapping of ventricular defibrillation with monophasic and biphasic shocks in dogs. Circ Res 1993;72:145–160.PubMedCrossRefGoogle Scholar
  49. 49.
    Daubert JP, Frazier DW, Wolf PD, et al. Response of relatively refractory canine myocardium to monophasic and biphasic shocks. Circulation 1991;84:2522–2538.PubMedCrossRefGoogle Scholar
  50. 50.
    Swartz JF, Jones JL, Jones RE, et al. Conditioning prepulse of biphasic defibrillator waveforms enhances refractoriness to fibrillation wavefronts. Circ Res 1991;68:438–449.PubMedCrossRefGoogle Scholar
  51. 51.
    Kroll MW. A minimal model of the single capacitor biphasic waveform. PACE 1994;17:1782–1792.PubMedCrossRefGoogle Scholar
  52. 52.
    Walcott GP, Walker RG, Cates AW, et al. Choosing the optimal monophasic and biphasic waveforms for ventricular defibrillation. J Cardiovasc Electrophysiol 1995;6:737–750.PubMedCrossRefGoogle Scholar
  53. 53.
    Sweeney RJ, Gill RM, Jones JL, et al. Defibrillation using a high-frequency series of monophasic rectangular pulses: observations and model predictions. J Cardiovasc Electrophysiol 1996;7:134–143.PubMedCrossRefGoogle Scholar
  54. 54.
    Swerdlow CD, Fan W, Brewer JE. Charge-burping correctly predicts optimal ratios of phase duration for biphasic defibrillation waveforms. Circulation 1996;94:2278–2284.PubMedCrossRefGoogle Scholar
  55. 55.
    Chapman PD, Wetherbee JN, Vetter JW, et al. Comparison of monophasic, biphasic, and triphasic truncated pulses for non-thoracotomy internal defibrillation. J Am Coll Card 1988;11:57A. (abstract)Google Scholar
  56. 56.
    Jones JL, Jones RE. Improved safety factors for triphasic defibrillator waveforms. Circ Res 1989;64:1172–1177.PubMedCrossRefGoogle Scholar
  57. 57.
    Walcott GP, Rollins DL, Smith WM, et al. Effect of changing capacitors between phases of a biphasic defibrillation shock. PACE 1996;19:945–954.PubMedCrossRefGoogle Scholar
  58. 58.
    Fujiyama Tchou P, Brewer JE, et al. Defibrillation thresholds with parallel series waveforms. Circulation 1996;94:1768–1773.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Susan M. Blanchard
  • Raymond E. Ideker
  • Randolph A. S. Cooper
  • J. Marcus Wharton

There are no affiliations available

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