Electrocardiographic Recording Direction Impacts Ventricular Fibrillation Waveform Measurements: A Potential Pitfall for VF-waveform Guided Defibrillation Protocols

Overview

Journal Resusc Plus

Date 2021 Jul 5

PMID 34223374

Citations 2

Authors

Jos Thannhauser

Joris Nas

Priya Vart

Joep L R M Smeets

Menko-Jan de Boer

Niels van Royen

Judith L Bonnes

Marc A Brouwer

Affiliations

Soon will be listed here.

Abstract

Aim: In cardiac arrest, ventricular fibrillation (VF) waveform analysis has identified the amplitude spectrum area (AMSA) as a key predictor of defibrillation success and favorable neurologic survival. New resuscitation protocols are under investigation, where prompt defibrillation is restricted to cases with a high AMSA. Appreciating the variability of in-field pad placement, we aimed to assess the impact of recording direction on AMSA-values, and the inherent defibrillation advice.

Methods: Prospective VF-waveform study on 12-lead surface electrocardiograms (ECGs) obtained during defibrillation testing in ICD-recipients (2010-2017). AMSA-values (mVHz) of simultaneous VF-recordings were calculated and compared between all limb leads, with lead II as reference (proxy for in-field pad position). AMSA-differences between leads I and II were quantified using Bland-Altman analysis. Moreover, we investigated differences between these adjacent leads regarding classification into high (≥15.5), intermediate (6.5-15.5) or low (≤6.5) AMSA-values.

Results: In this cohort (n = 243), AMSA-values in lead II (10.2 ± 4.8) differed significantly from the other limb leads (I: 8.0 ± 3.4; III: 12.9 ± 5.6, both p < 0.001). The AMSA-value in lead I was, on average, 2.24 ± 4.3 lower than in lead II. Of the subjects with high AMSA-values in lead II, only 15% were classified as high if based on assessments of lead I. For intermediate and low AMSA-values, concordances were 66% and 72% respectively.

Conclusions: ECG-recording direction markedly affects the result of VF-waveform analysis, with 20-30% lower AMSA-values in lead I than in lead II. Our data suggest that electrode positioning may significantly impact shock guidance by 'smart defibrillators', especially affecting the advice for prompt defibrillation.

Citing Articles

ECG analysis of ventricular fibrillation dynamics reflects ischaemic progression subject to variability in patient anatomy and electrode location.

Martinez-Navarro H, Bertrand A, Doste R, Smith H, Tomek J, Ristagno G Front Cardiovasc Med. 2024; 11:1408822.

PMID: 39664764 PMC: 11631900. DOI: 10.3389/fcvm.2024.1408822.

Amplitude spectrum area is dependent on the electrocardiogram magnitude: evaluation of different normalization approaches.

Silva L, Gaudio H, Widmann N, Forti R, Padmanabhan V, Senthil K Physiol Meas. 2024; 45(11).

PMID: 39536707 PMC: 11653958. DOI: 10.1088/1361-6579/ad9233.

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