Choosing the Optimal Monophasic and Biphasic Waveforms for Ventricular Defibrillation

Optimal Monophasic and Biphasic Waveforms. Introduction: The truncated exponential waveform from an implantable cardioverter defibrillator can be described by three quantities: the leading edge voltage, the waveform duration, and the waveform time coastant (τs). The goal of this work was to develop and test a mathematical model of defibrillation that predicts the optimal durations for monophasic and the first phase of biphasic waveforms for different τs values. In 1932, Blair used a parallel resistor‐capacitor network as a model of the cell membrane to develop an equation that describes stimulation using square waves. We extended Blair's model of stimulation, using a resistor‐capacitor network time constant (τm), equal to 2.8 msec, to explicitly account for the waveform shape of a truncated exponential waveform. This extended model predicted that for monophasic waveforms with τs of 1.5 msec, leading edge voltage will be constant for waveforms 2 msec and longer; for τs of 3 msec, leading edge voltage will be constant for waveforms 3 msec and longer; for τs of 6 msec, leading edge voltage will be constant for waveforms 4 msec and longer. We hypothesized that the best phase 1 of a biphasic waveform is the best monophasic waveform. Therefore, the optimal first phase of a biphasic waveform for a given τs is the same as the optimal monophasic waveform.

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