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.

中文翻译：

---

潜在 ST 段抬高心肌梗死的定位对 VF 波形的影响：一项多中心心脏骤停研究

介绍

在心脏骤停中，研究室颤 (VF) 波形特征，例如振幅谱面积 (AMSA)，以确定潜在的心肌梗塞 (MI)。观察性研究报告显示，有基础 MI 的患者的 AMSA 值低于无基础 MI 的患者。此外，当 MI 定位与心电图记录方向匹配时，12 导联心电图记录的实验研究显示出最低的 VF 特性。然而，缺乏使用除颤器衍生的 VF 记录的院外心脏骤停 (OHCA) 研究。

方法

关于 AMSA、ST 海拔 MI (STEMI) 及其定位之间关联的多中心（阿姆斯特丹/荷兰奈梅亨）队列研究。AMSA 是根据除颤器垫心电图记录计算的（II 导联的代理，劣势）；使用心电图/血管造影/尸检结果确定 STEMI 定位。

结果

我们研究了 754 名 OHCA 患者的 AMSA 值。无 STEMI、前 STEMI 和下 STEMI（奈梅亨：无 STEMI 13.0mVHz [7.9-18.6]，前 STEMI 7.5mVHz [5.6-13.8]，下 STEMI 7.5mVHz [5.4-11.8]，p = 0.006）之间存在统计学显着差异. 阿姆斯特丹：分别为 11.7mVHz [5.0–21.9]、9.6mVHz [4.6–17.2] 和 6.9mVHz [3.2–16.0]，p = 0.001）。单变量分析显示，与无 STEMI 相比，劣质 STEMI 的 AMSA 值显着降低；前和无 STEMI 之间没有显着差异。校正混杂因素后，两个队列中下位 STEMI 的调整后绝对 AMSA 值在数值上最低，下位 STEMI 和无 STEMI 之间 AMSA 的相对差异比前位 STEMI 和无 STEMI 之间大 1.4-1.7 倍。

结论

这种多中心 VF 波形 OHCA 研究显示，在潜在 STEMI 的情况下，AMSA 显着降低，下位 STEMI 的差异比前位 STEMI 更明显。有必要对 STEMI 定位对 VF 波形的影响进行确认性研究，这可能有助于早期诊断 VF 期间的 STEMI。