Abstract
IntroductionIn cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI). Observational studies report lower AMSA-values in patients with than without underlying MI. Moreover, experimental studies with 12-lead ECG-recordings show lowest VF-characteristics when the MI-localisation matches the ECG-recording direction. However, out-of-hospital cardiac arrest (OHCA)-studies with defibrillator-derived VF-recordings are lacking. MethodsMulti-centre (Amsterdam/Nijmegen, the Netherlands) cohort-study on the association between AMSA, ST-elevation MI (STEMI) and its localisation. AMSA was calculated from defibrillator pad-ECG recordings (proxy for lead II, inferior vantage point); STEMI-localisation was determined using ECG/angiography/autopsy findings. ResultsWe studied AMSA-values in 754 OHCA-patients. There were statistically significant differences between no STEMI, anterior STEMI and inferior STEMI (Nijmegen: no STEMI 13.0mVHz [7.9–18.6], anterior STEMI 7.5mVHz [5.6–13.8], inferior STEMI 7.5mVHz [5.4–11.8], p = 0.006. Amsterdam: 11.7mVHz [5.0–21.9], 9.6mVHz [4.6–17.2], and 6.9mVHz [3.2–16.0], respectively, p = 0.001). Univariate analyses showed significantly lower AMSA-values in inferior STEMI vs. no STEMI; there was no significant difference between anterior and no STEMI. After correction for confounders, adjusted absolute AMSA-values were numerically lowest for inferior STEMI in both cohorts, and the relative differences in AMSA between inferior and no STEMI was 1.4–1.7 times larger than between anterior and no STEMI. ConclusionThis multi-centre VF-waveform OHCA-study showed significantly lower AMSA in case of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Confirmative studies on the impact of STEMI-localisation on the VF-waveform are warranted, and might contribute to earlier diagnosis of STEMI during VF.
Highlights
In cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI)
The present multi-centre VF-waveform study of 754 of-hospital cardiac arrest (OHCA)-patients using ECG-recordings from defibrillator pads is the first to report on differences in AMSA in relation to underlying ST-elevation MI (STEMI) and its localisation
AMSA was significantly lower in case of STEMI, with an absolute value that was 17% lower for inferior STEMI compared to no STEMI, for both cohorts
Summary
Ventricular fibrillation (VF) is the presenting cardiac rhythm in approximately 30–50% of out-of-hospital cardiac arrests (OHCA). Several VF-waveform studies demonstrated that the amplitude spectrum area (AMSA) predicts chances of defibrillation success and favourable (neurologically intact) survival.[4,5,6,7,8]. Another potential application of VF-analysis might be early identification of the underlying arrest cause, while the patient is in VF. We conduct a multi-centre VFwaveform study in a larger series of patients to investigate the association between AMSA, STEMI and its localisation in two independent, established Dutch OHCA-cohorts
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