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Actibiphasic Defibrillation

Contents

Arrhythmias Required Defibrillation Effective Defibrillation Monophasic Discharge Waveform Monophasic/Actibiphasic Discharge Waveform Actibiphasic Discharge Waveform TEC-5500/7700 series Defibrillation Waveform Display Summary

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Arrhythmias Required Defibrillation


Atrial Fibrillation (Af)
Irregular excitement everywhere in atria Irregular R-R rhythm Reduced pumping (-20 % or less cardiac output)

Atrial Flutter (AFL)


High rate excitement in atria (Over 250/minute) Irregular R-R Increased heart rate Reduced pumping

Ventricular Tachycardia (VT) Ventricular Fibrillation (VF)


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
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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 effects such as damage to the cardiac muscle, cardiac dysfunction, arrhythmia occurrence, skin burn.

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

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Monophasic Discharge Waveform

Edmark waveform
Chest impedance

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In Monophasic defibrillation

Effective defibrillation depends on impedance and discharge waveform shape. High impedance reduces the defibrillation efficiency and causes a 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. 5/16

Monophasic/Actibiphasic Discharge Waveform


60 A at 360 J, 50 ohm 40 A at 270 J, 50 ohm

Monophasic waveform

Actibiphasic waveform

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ActiBiphasic
Nihon Kohden Added Innovation to Biphasic Technology

A dvanced C ontrol T -circuit I ntegrated Biphasic

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Biphasic circuit block diagram


H-bridge T-circuit

Patient

Commonly used circuit for biphasic

NK original circuit
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H Bridge circuit block diagram

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SW1

SW3

SW2

SW4

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H Bridge circuit block diagram 2/2

SW1

SW3

SW2

SW4

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Conceptual Diagram of T - circuit 1/2

SW 1

SW 2

SW 3

Patient

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Conceptual Diagram of T - circuit 2/2

SW 1

SW 2

SW 3

Patient

Blue: When closing SW1 and SW3 Red: When opening SW1 and closing SW3
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ActiBiphasic Discharge Waveform


First phase: Truncated exponential waveform

Current: 37%

Second phase: Controlled within 4 ms and constant power

Defibrillation duration within 20 ms Delivered energy: 270 J


Load resistance () First phase Ipk1 (A) D1 (ms)

Key point for Effective defibrillation


Second phase Ipk2 (A) D2 (ms)

25 50 75 100 125 150 175

67.3 41.1 29.5 22.9 18.8 15.9 13.8

3.85 6.35 8.86 11.4 13.9 16.4 18.9

15.5 12.7 11.0 9.81 8.96 8.29 7.76

3.62 3.62 3.62 3.62 3.62 3.62 3.62


Constant duration

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Biphasic Discharge Waveform


TEC-5500/7700
50

Conventional Biphasic

75

100

125

150

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TEC-5500/7700 series Defibrillation Waveform Display


In the Basic checks screen, you can check the Actibiphasic discharge waveform.

Delivered Energy TTR (transthoracic resistance) Voltage (peak of the first phase) Phase 1 (duration of first phase) Phase 2 (duration of second phase)
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Summary - ActiBiphasic Defibrillation

ActiBiphasic defibrillation gives lower energy than monophasic defibrillation.


At 75% of the energy of monophasic defibrillation, Actibiphasic defibrillation shows better result.

ActiBiphasic defibrillation may cause less damage to cardiac muscle.

Because it gives lower energy and lower peak current than monophasic defibrillation. In internal defibrillation, Actibiphasic defibrillation also 16/16 shows very good results.