Document Detail

Utility of the ventricular fibrillation waveform to predict a return of spontaneous circulation and distinguish acute from post myocardial infarction or normal Swine in ventricular fibrillation cardiac arrest.
MedLine Citation:
PMID:  21493961     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In cardiac arrest, the ventricular fibrillation (VF) waveform, particularly amplitude spectral area (AMSA) and slope, predicts the return of spontaneous circulation (ROSC), but it is unknown whether the predictive utility differs in an acute myocardial infarction (MI), prior MI, or normal myocardium and if the waveform can distinguish the underlying myocardial state. We hypothesized that in a swine model of VF cardiac arrest, AMSA and slope predict ROSC after a shock independent of substrate and distinguish an acute from nonacute MI state.
METHODS AND RESULTS: MI was induced by occlusion of the left anterior descending artery. Post MI swine recovered for a 2-week period before induction of VF. VF was untreated for 8 minutes in 10 acute MI, 10 post MI, and 10 control swine. AMSA and slope predicted ROSC after a shock independent of myocardial state. For AMSA >31 mV-Hz, the odds ratio was 62 (P≤0.001) compared with AMSA <19 mV-Hz. For slope >3.1 mV/s, odds ratio was 52 (P≤0.001) compared with slope <1.8 mV/s. With chest compressions, AMSA and slope were significantly lower for acute MI swine compared with control swine, whereas in post MI swine the waveform characteristics were similar to control swine. In particular, for an AMSA >33.5 mV-Hz, the sensitivity to identify an acute from nonacute (control or post MI) state was 83%.
CONCLUSIONS: In a swine model of VF cardiac arrest, AMSA and slope predict ROSC independent of myocardial substrate. Furthermore, with chest compressions, the VF waveform evolves differently and may offer a means to distinguish an acute MI.
Julia H Indik; Daniel Allen; Michael Gura; Christian Dameff; Ronald W Hilwig; Karl B Kern
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-14
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  4     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-15     Completed Date:  2011-09-01     Revised Date:  2012-02-03    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  337-43     Citation Subset:  IM    
Sarver Heart Center, University of Arizona College of Medicine, Tucson, 85724-5037, USA.
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MeSH Terms
Blood Circulation / physiology*
Cardiopulmonary Resuscitation / methods
Diagnosis, Differential
Disease Models, Animal
Heart Arrest / diagnosis,  etiology*
Myocardial Infarction / complications*,  diagnosis
Predictive Value of Tests
Recovery of Function*
Ventricular Fibrillation / complications,  diagnosis*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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