Is the Best (Waveform) the Enemy of the Good (Waveform)? A Defibrillation Challenge

摘要

Since the demonstration of successful clinical defibrillation by electrical shock in 1947 (1), the evolution of defibrillators has focused on the pursuit of defibrillator waveforms that can reliably and reproducibly terminate ventricular fibrillation without incurring myocardial damage. The waveform of an electrical shock is defined as the temporal pattern of its amplitude measured by voltage or current. After a long period of monophasic waveform configurations, a more efficient biphasic waveform was introduced. All current implantable cardioverter-defibrillators (ICD) use biphasic truncated exponential (BTE) waveforms to defibrillate. The use of these exponential decaying morphologies is based on the simplicity and reliability of modern capacitors as the main component of energy delivery, which in turn, makes it possible to generate the current in relatively small implantable devices.