The effect of the localisation of an underlying ST-elevation myocardial infarction on the VF-waveform: A multi-centre cardiac arrest study

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Article

Nas, J.¹  van Dongen, L. H.²  Thannhauser, J.¹  Hulleman, M.²  van Royen, N.¹  Tan, H. L.^2,3  Bonnes, J. L.¹  Koster, R. W.²  Brouwer, M. A.¹  Blom, M. T.² 

[1] Radboud Univ Nijmegen, Dept Cardiol, Med Ctr, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[2] Locat AMC, Amsterdam UMC, Dept Cardiol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands

[3] Netherlands Heart Inst, Utrecht, Netherlands

关键词: Out-of-hospital cardiac arrest;    Ventricular fibrillation;    Waveform analysis;    ST-elevation myocardial infarction;   

DOI  :  10.1016/j.resuscitation.2021.08.049

来源: Elsevier

【 摘 要 】

Introduction: In 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. Methods: Multi-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. Results: We 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. Conclusion: This 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.

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