Electrocardiographic recording direction impacts ventricular fibrillation waveform measurements: A potential pitfall for VF-waveform guided defibrillation protocols

Jos Thannhauser; Joris Nas; Priya Vart; Joep L.R.M. Smeets; Menko-Jan de Boer; Niels van Royen; Judith L. Bonnes; Marc A. Brouwer

doi:10.1016/j.resplu.2021.100114

Electrocardiographic recording direction impacts ventricular fibrillation waveform measurements: A potential pitfall for VF-waveform guided defibrillation protocols

Jos Thannhauser^*, Joris Nas, Priya Vart, Joep L.R.M. Smeets, Menko-Jan de Boer, Niels van Royen, Judith L. Bonnes, Marc A. Brouwer

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Article number	100114
Journal	Resuscitation Plus
Volume	6
DOIs	https://doi.org/10.1016/j.resplu.2021.100114
Publication status	Published - Jun 2021
Externally published	Yes

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1-s2.0-S2666520421000394-mainFinal published version, 1.21 MBLicence: CC BY

Cite this

@article{9ec081485814474b8c5b56f210983e8a,

title = "Electrocardiographic recording direction impacts ventricular fibrillation waveform measurements: A potential pitfall for VF-waveform guided defibrillation protocols",

abstract = "AimIn 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.MethodsProspective 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.ResultsIn 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.ConclusionsECG-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 {\textquoteleft}smart defibrillators{\textquoteright}, especially affecting the advice for prompt defibrillation.",

author = "Jos Thannhauser and Joris Nas and Priya Vart and Smeets, {Joep L.R.M.} and Boer, {Menko-Jan de} and Royen, {Niels van} and Bonnes, {Judith L.} and Brouwer, {Marc A.}",

year = "2021",

month = jun,

doi = "10.1016/j.resplu.2021.100114",

language = "English",

volume = "6",

journal = "Resuscitation Plus",

issn = "2666-5204",

publisher = "Elsevier",

}

TY - JOUR

T1 - Electrocardiographic recording direction impacts ventricular fibrillation waveform measurements

T2 - A potential pitfall for VF-waveform guided defibrillation protocols

AU - Thannhauser, Jos

AU - Nas, Joris

AU - Vart, Priya

AU - Smeets, Joep L.R.M.

AU - Boer, Menko-Jan de

AU - Royen, Niels van

AU - Bonnes, Judith L.

AU - Brouwer, Marc A.

PY - 2021/6

Y1 - 2021/6

N2 - AimIn 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.MethodsProspective 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.ResultsIn 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.ConclusionsECG-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.

AB - AimIn 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.MethodsProspective 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.ResultsIn 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.ConclusionsECG-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.

U2 - 10.1016/j.resplu.2021.100114

DO - 10.1016/j.resplu.2021.100114

M3 - Article

VL - 6

JO - Resuscitation Plus

JF - Resuscitation Plus

SN - 2666-5204

M1 - 100114

ER -

Electrocardiographic recording direction impacts ventricular fibrillation waveform measurements: A potential pitfall for VF-waveform guided defibrillation protocols

Abstract

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