Simultaneous Comparison of Many Triphasic Defibrillation Waveforms

Biphasic defibrillation waveforms are now accepted as being more effective at terminating ventricular fibrillation (VF) than monophasic waveforms. If two phases are better than one, this naturally leads to the hypothesis that additional phases improve efficacy. This study tests the hypothesis by adding one additional phase. We examined the efficacy of 18 different triphasic waveforms simultaneously. We tested the rate of recovery, i.e., successful defibrillation, of 21 guinea pigs (820-1,050 g) using triphasic, monophasic and biphasic defibrillation waveforms. The biphasic and monophasic were control waveforms. VF was electrically induced twenty times per animal and a single defibrillation attempt was made using a test waveform VF episode. Every waveform was adjusted to the energy required to defibrillate that animal 50% of the time, using a biphasic waveform as a control. The success rate of each triphasic waveform was pair-wise compared to the biphasic and monophasic control using the adjusted McNemar statistical test. Of the 18 triphasic waveforms tested, two were significantly poorer than the monophasic control (p<0.05). One was superior to the biphasic waveform (p<0.1), but not statistically so. We concluded that, while adding a phase to a monophasic waveform does improve efficacy, adding an additional phase to a biphasic waveform does not necessarily improve efficacy.