{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:27:11Z","timestamp":1761560831106},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2003,7,22]],"date-time":"2003-07-22T00:00:00Z","timestamp":1058832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:p> <jats:italic>Introduction:<\/jats:italic> We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500\u2010\u03bcF capacitor with 40% tilt was compared to a standard biphasic waveform generated by a 60\u2010\u03bcF capacitor with 80% tilt.<\/jats:p><jats:p> <jats:italic>Methods and Results:<\/jats:italic> In 19 patients with paroxysmal atrial fibrillation (79% male, age <jats:styled-content>55 \u00b1 11<\/jats:styled-content> years, 21% with heart disease), the atrial defibrillation threshold (ADFT) was determined during deep sedation with midazolam for both waveforms in a randomized fashion using a step\u2010up protocol. Internal cardioversion with a single lead (shock vector: coronary sinus to right atrium) was successful in 18 (95%) of 19 patients. ADFT energy and peak voltage were significantly lower for the low\u2010voltage waveform (<jats:styled-content>2.1 \u00b1 2.4<\/jats:styled-content> J vs <jats:styled-content>3.5 \u00b1 3.9 J, P &lt; 0.01; 100 \u00b1 53 V<\/jats:styled-content> vs <jats:styled-content>290 \u00b1 149 V, P &lt; 0.01<\/jats:styled-content>). Sedation then was reversed with flumazenil after ADFT testing. Two shocks at the ADFT (or a 3\u2010J shock if ADFT &gt;3 J) were administered to the patient using each waveform in random order. Pain perception was assessed using both a visual scale and a numerical score. ADFTs were above the pain threshold in 17 (94%) of 18 patients, even though the ADFT with the 500\u2010\u03bcF waveform was &lt;100 V in 63% of the patients. Pain perception was comparable for both waveforms (numerical score: <jats:styled-content>6.5 \u00b1 2.4<\/jats:styled-content> vs <jats:styled-content>6.3 \u00b1 2.6<\/jats:styled-content>; visual scale: <jats:styled-content>5.4 \u00b1 2.6<\/jats:styled-content> vs <jats:styled-content>5.2 \u00b1 3.1; P = NS, 500\u2010\u03bcF<\/jats:styled-content> vs <jats:styled-content>60\u2010\u03bcF<\/jats:styled-content>). The second shock was perceived as more painful in 88% of the patients, independent of the waveform used.<\/jats:p><jats:p> <jats:italic>Conclusion:<\/jats:italic> Despite a 66% lower peak voltage and a 40% lower energy, the 40% tilt, 500\u2010\u03bcF capacitor biphasic waveform did not change the pain perceived by the patient during delivery of internal cardioversion shocks. Pain perception for internal cardioversion probably is not influenced by peak voltage alone and increases with the number of applied shocks. <jats:italic>(J Cardiovasc Electrophysiol, Vol. 14, pp. 837\u2010840, August 2003)<\/jats:italic><\/jats:p>","DOI":"10.1046\/j.1540-8167.2003.02557.x","type":"journal-article","created":{"date-parts":[[2003,7,22]],"date-time":"2003-07-22T10:15:13Z","timestamp":1058868913000},"page":"837-840","source":"Crossref","is-referenced-by-count":12,"title":["Defibrillation Efficacy and Pain Perception of Two Biphasic Waveforms for Internal Cardioversion of Atrial Fibrillation"],"prefix":"10.1111","volume":"14","author":[{"given":"Jens","family":"Jung","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanos","family":"Siaplaouras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Buob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd D.","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Heisel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2003,7,22]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1962.03050440040012"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00555-5"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00274-4"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.75.6.635"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1996.tb03374.x"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a015175"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1997.tb01823.x"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.1.253"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(99)00116-3"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00220-3"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1997.tb04849.x"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00733-9"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1996.tb03312.x"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1053\/eupc.2001.0184"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.16.1651"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.12.1407"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1994.tb01460.x"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00583-9"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2002.01090.x"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1540-8167.2003.02557.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1046\/j.1540-8167.2003.02557.x","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1046\/j.1540-8167.2003.02557.x","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1046\/j.1540-8167.2003.02557.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T06:49:09Z","timestamp":1694414949000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1540-8167.2003.02557.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,7,22]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2003,8]]}},"alternative-id":["10.1046\/j.1540-8167.2003.02557.x"],"URL":"https:\/\/doi.org\/10.1046\/j.1540-8167.2003.02557.x","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,7,22]]}}}