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Actibiphasic Defibrillation

ContentsContents Arrhythmias Required DefibrillationArrhythmias Required Defibrillation Effective Defibrillation Monophasic Discharge WaveformMonophasic Discharge Waveform Monophasic/Actibiphasic Discharge WaveformMonophasic/Actibiphasic Discharge Waveform Actibiphasic Discharge WaveformActibiphasic Discharge Waveform TEC-5500/7700 series DefibrillationTEC-5500/7700 series Defibrillation Waveform Waveform

DisplayDisplay SummarySummary

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Atrial Fibrillation (Af)Atrial Fibrillation (Af)

ArrhythmiasArrhythmias Required Defibrillation Required Defibrillation

Atrial Flutter (AFL)Atrial Flutter (AFL)

Ventricular Tachycardia (VT)Ventricular Tachycardia (VT)Ventricular Fibrillation (VF)Ventricular Fibrillation (VF)

•Irregular excitement everywhere in atria

•Irregular R-R rhythm•Reduced pumping (-20 % or less cardiac output)

•High rate ventricular contraction

•Greatly reduced cardiac output depending on high heart rate

•Irregular excitement everywhere in ventricles

•Just quivering, no contraction

•No blood circulation

•High rate excitement in atria(Over 250/minute)

•Irregular R-R•Increased heart rate•Reduced pumping

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Effective Defibrillation is To deliver all the necessary energy

to a patient with any impedance.

To give lower energy to prevent side To give lower energy to prevent side effects such as damage to the cardiac effects such as damage to the cardiac muscle, cardiac dysfunction, muscle, cardiac dysfunction, arrhythmia occurrence, skin burn.arrhythmia occurrence, skin burn.

Lower energy and lower peak current Lower energy and lower peak current are required for less side effects.are required for less side effects.

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Monophasic Discharge Monophasic Discharge WaveformWaveform

Edmark waveform

Chest impedance

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In Monophasic defibrillationIn Monophasic defibrillation Effective defibrillation depends on Effective defibrillation depends on impedance impedance

andand discharge waveform shape. discharge waveform shape. High impedance reduces the defibrillation High impedance reduces the defibrillation

efficiency and causes a efficiency and causes a longer defibrillation time.longer defibrillation time.

If the defibrillation is supposed to last more than 20 ms due to high impedance, this may cause VF occurrence. It requires more energy especially in monophasic defibrillation.

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60 A at 360 J, 50 ohm

Monophasic waveform Actibiphasic waveform

40 A at 270 J, 50 ohm

Monophasic/Actibiphasic Monophasic/Actibiphasic Discharge WaveformDischarge Waveform

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ActiBiphasicActiBiphasic

Nihon Kohden Added Innovation to Nihon Kohden Added Innovation to Biphasic TechnologyBiphasic Technology

A A dvanceddvancedC C ontrolontrolT T -circuit-circuitI I ntegratedntegratedB i p h a s i B i p h a s i cc

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Biphasic circuit block Biphasic circuit block diagramdiagram

Patient

T-circuitT-circuit

NK original circuit

H-bridgeH-bridge

Commonly used circuit for biphasic

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H Bridge circuit block H Bridge circuit block diagramdiagram

1/21/2

SW1

SW2

SW3

SW4

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SW1

SW2

SW3

SW4

H Bridge circuit block H Bridge circuit block diagramdiagram

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Conceptual Diagram of T - circuit 1/21/2

Patient

SW 1 SW 2

SW 3

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Patient

SW 1 SW 2

SW 3

Blue: When closing SW1 and SW3

Red: When opening SW1 and closing SW3

Conceptual Diagram of T - circuit 2/2

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ActiBiphasic Discharge ActiBiphasic Discharge WaveformWaveform

Constant duration

Defibrillation duration within 20 ms

Current: 37%

Second phase: Controlled within 4 msand constant power

First phase: Truncated exponential waveform

First phase Second phaseLoad resistance() Ipk1 (A) D1 (ms) Ipk2 (A) D2 (ms)25 67.3 3.85 15.5 3.6250 41.1 6.35 12.7 3.6275 29.5 8.86 11.0 3.62100 22.9 11.4 9.81 3.62125 18.8 13.9 8.96 3.62150 15.9 16.4 8.29 3.62175 13.8 18.9 7.76 3.62

Delivered energy: 270 J Key point for Effective defibrillation

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50

75

100

125

150

TEC-5500/7700

Conventional Biphasic

Biphasic Discharge WaveformBiphasic Discharge Waveform

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TEC-5500/7700 seriesTEC-5500/7700 seriesDefibrillation Waveform Defibrillation Waveform DisplayDisplay

In the “Basic checks” screen, In the “Basic checks” screen, you can check the you can check the ActiActibiphasic biphasic discharge waveform.discharge waveform. Delivered EnergyDelivered Energy TTR (transthoracic resistance)TTR (transthoracic resistance) Voltage (peak of the first phase)Voltage (peak of the first phase) Phase 1 (duration of first phase)Phase 1 (duration of first phase) Phase 2 (duration of second Phase 2 (duration of second phase)phase)

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Summary - ActiBiphasic DefibrillationSummary - ActiBiphasic Defibrillation

ActiBiphasic defibrillation gives lower ActiBiphasic defibrillation gives lower energy than monophasic defibrillation. energy than monophasic defibrillation. At 75% of the energy of monophasic At 75% of the energy of monophasic defibrillation, Actibiphasic defibrillation shows defibrillation, Actibiphasic defibrillation shows better result.better result.

ActiActiBiphasic defibrillation may cause Biphasic defibrillation may cause less damage to cardiac muscle.less damage to cardiac muscle.Because it gives lower energy and lower peak Because it gives lower energy and lower peak current than monophasic defibrillation.current than monophasic defibrillation.

In internal defibrillation, Actibiphasic In internal defibrillation, Actibiphasic defibrillation also shows very good results.defibrillation also shows very good results.