Ventricular fibrillation waveform characteristics of the surface ECG: Impact of the left ventricular diameter and mass

Judith L. Bonnes, Jos Thannhauser, Joris Nas, Sjoerd W. Westra, Rutger M.G. Jansen, Gjerrit Meinsma, Menko-Jan de Boer, Joep L.R.M. Smeets, Wessel Keuper, Marc A. Brouwer

    Research output: Contribution to journalArticleAcademicpeer-review

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    Abstract

    Background
    Despite a promising association between VF waveform characteristics and prognosis after resuscitation, studies with VF-guided treatment have so far not improved outcomes. While driven by the idea that the VF waveform reflects arrest duration, increasing evidence suggests that pre-existent disease-related changes of the myocardium affect ECG-characteristics of VF as well. In this context, we studied the impact of the left ventricular (LV) diameter and mass.

    Methods
    Cohort of 193 ICD-patients with defibrillation testing at the Radboudumc (2010–2014). Surface ECG-recordings (leads I,II,aVF,V1,V3,V6) were analysed to study amplitude and frequency characteristics of the induced VF. Both for LV diameter and mass, patients were categorised in two groups, using echocardiographic data (ASE-guidelines).

    Results
    In all ECG-leads, dominant and median frequencies were significantly lower in patients with (n = 40) than in patients without (n = 151) an increased LV diameter. The mean amplitude and amplitude spectrum area (AMSA) did not differ. In contrast, we observed no differences in frequency characteristics in relation to the LV mass, whereas mean amplitude (I,aVF,V3) and AMSA (I,V3) were significantly higher in patients with (n = 57) than in patients without (n = 120) an increased LV mass.

    Conclusions
    Frequency characteristics of VF were consistently lower in case of an increased LV diameter. Whereas LV mass does not affect the frequency of the VF waveform, amplitudes seem higher with increasing mass. These findings add to the current knowledge of factors that modulate VF characteristics of the surface ECG and provide insight into factors which may be accounted for in future studies on VF-guided resuscitative interventions.
    Original languageEnglish
    Pages (from-to)82-89
    Number of pages8
    JournalResuscitation
    Volume115
    DOIs
    Publication statusPublished - 2017

    Keywords

    • Ventricular fibrillation
    • Fourier analysis
    • Electrocardiography
    • Left ventricular mass
    • Left ventricular diameter
    • Implantable cardioverter defibrillator

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