Ascending-ramp biphasic waveform has a lower defibrillation threshold and releases less troponin I than a truncated exponential biphasic waveform.
Ascending-ramp biphasic waveform has a lower defibrillation threshold and releases less troponin I than a truncated exponential biphasic waveform.
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DOI：
10.1161/circulationaha.112.109777
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发表时间：
2012-09-11
期刊：
影响因子：
37.8
通讯作者：
Ideker RE
中科院分区：
文献类型：
--
作者：
Huang J;Walcott GP;Ruse RB;Bohanan SJ;Killingsworth CR;Ideker RE
我们测试了电击波形的形状不仅影响除颤阈值（DFT），而且影响心脏损伤量的假设。确定了11个波形的DFT：3个上升斜坡、3个下降斜坡和3个直线第一相双相波形、Gurvich波形和6只猪的截断指数双相波形，电极位于RV心尖和SVC。上升、下降和直线波形具有4、8和16 ms的第一相位和3.5 ms的第二直线相位，第二直线相位是第一相位电压的一半。指数双相波形具有60%的第一相位和50%的第二相位倾斜。在第二项研究中，我们尝试在VF 10 s后用单次1000 J电击进行除颤（6头猪用8 ms上升波、8 ms直线波和截短指数双相波形成功除颤）。在休克前和休克后2至10小时测定肌钙蛋白I血液水平。最低能量DFT为8 ms上升斜坡（14.6±7.3 SD J），显著低于截断指数（19.6±6.3 J）。休克后6小时，肌钙蛋白I（ng/ml）在上升斜坡（0.80±0.54）中显著低于截短指数波形（1.92±0.47）或直线波形（1.17 ±0.45）。与截短指数双相休克相比，上升斜坡具有显著较低的DFT，并且在10030 J时引起的肌钙蛋白I释放减少58%。因此，冲击波形影响DFT和心脏损伤量。
We tested the hypothesis that the shape of the shock waveform affects not only the defibrillation threshold (DFT), but also the amount of cardiac damage. DFTs were determined for 11 waveforms: 3 ascending ramp, 3 descending ramp, and 3 rectilinear first phase biphasic waveforms, a Gurvich waveform, and a truncated exponential biphasic waveform in 6 pigs with electrodes in the RV apex and SVC. The ascending, descending and rectilinear waveforms had 4, 8 and 16 ms 1st phases and a 3.5 ms 2nd rectilinear phase half the voltage of the 1st phase. The exponential biphasic waveform had a 60% 1st phase and a 50% 2nd phase tilt. In a second study, we attempted to defibrillate after 10 s of VF with a single ≈ 30 J shock (6 pigs successfully defibrillated with 8 ms ascending, 8 ms rectilinear wave and truncated exponential biphasic waveforms). Troponin I blood levels were determined before and 2 to 10 hrs after the shock. The lowest energy DFT was for the 8 ms ascending ramp (14.6±7.3 SD J), which was significantly less than for the truncated exponential (19.6±6.3 J). Six hours postshock, troponin I in ng/ml was significantly less for the ascending ramp (0.80±0.54) than for the truncated exponential (1.92±0.47) or the rectilinear waveform (1.17 ±0.45). The ascending ramp has a significantly lower DFT, and at ≈ 30 J causes 58% less troponin I release than the truncated exponential biphasic shock. Therefore, the shock waveform affects both the DFT and the amount of cardiac damage.