Predicting the Origin of Ventricular Arrhythmia Using Acoustic Cardiography

Chin Yu Lin ,Yao Ting Chang ,Shih Lin Chang ,Ting Chun Huang ,Tsan‐Kuo Chang ,Hoang Quang Minh ,Fa‐Po Chung ,Yu Feng Hu ,Hao Min Cheng ,Ling Kuo,Tze Fan Chao ,Li Wei Lo ,Jo Nan Liao ,Shinya Yamada,Ta Chuan Tuan ,Hsing Yuan Li ,Shih Hsien Sung ,Simon Salim,Shih Ann Chen

doi:10.1038/s41598-017-15573-5

Abstract

This study aimed to examine the relationship between measurements related to heart sounds and the origin of ventricular arrhythmia. We retrospectively evaluated 45 patients undergoing catheter ablation with contemporaneous digital acoustic cardiography of the first heart sound (S1) and the second heart sound (S2). The patients with baseline wide QRS morphology (>120 ms or aberrant conduction), heart failure, valvular heart disease, chronic pulmonary disease, and obesity were excluded. Ventricular arrhythmias from the left ventricle had an increased S1 complexity score and S1 duration in comparison to adjacent sinus beats. On the other hand, ventricular arrhythmia from right ventricle had decreased S1 complexity score and S1 duration in comparison to adjacent sinus beats. The difference of S1 (ΔS1) parameters between premature ventricular complex and sinus beat was significantly smaller in right ventricular arrhythmia group compared with and left ventricular arrhythmia group. For predicting the origin of ventricular arrhythmia, the ΔS1 duration provide better predictive accuracy (sensitivity: 100%, specificity: 100%, cutoff value: −1.28 ms) in comparison to ΔS1 complexity score (sensitivity 71.4%, specificity 75.0%, cutoff value: −0.13). The change of S1 complexity and duration determined from acoustic cardiography could accurately predict the ventricular arrhythmia origin.

Highlights

Previous study demonstrated that the reverse splitting second heart sound (S2), which required additional carotid pressure tracing tool, was associated with the origin of ectopies[2]
There was no significant difference in acoustic cardiographic measurement of sinus beats between Group 1 and Group 2 (Table 2)
Group 1 patients exhibited a negative change in S1 (ΔS1) complexity and S1 duration during ventricular beats compared to sinus rhythm (SR) beats

Summary

Introduction

Previous study demonstrated that the reverse splitting second heart sound (S2), which required additional carotid pressure tracing tool, was associated with the origin of ectopies[2]. Wide splitting of the S1 was observed in RBBB subjects[7,8] These studies demonstrated the wavefront of ventricular myocardial activation affect the timing of valvular closure, which could be detected and quantified by well-designed acoustic cardiography device. Acoustic cardiography is a cost-effective technology, which incorporates hemodynamic information and electrocardiac signals for clinical assessment[9]. Acoustic cardiography permits simultaneous acquisition of ECG and heart sound information and provides a computerized interpretation of these findings. The application of heart sounds in prediction of the origin of VA has been intensively investigated, it is not clinically available because of the lack of objectivity[2,10,11]. The present study was designed to test whether acoustic cardiography could provide information in differentiating the origin of VA in clinical practice

Objectives

Methods

Results

Discussion

Conclusion