Prompt prediction of successful defibrillation from 1-s ventricular fibrillation waveform in patients with out-of-hospital sudden cardiac arrest.
OBJECTIVE
Ventricular fibrillation (VF) is a common cardiac arrest rhythm that can be terminated by electrical defibrillation. During cardiopulmonary resuscitation, there is a strong need for a prompt and reliable predictor of successful defibrillation because myocardial damage can result from repeated futile defibrillation attempts. Continuous wavelet transform (CWT) provides excellent time and frequency resolution of signals. The purpose of this study was to evaluate whether features based on CWT could predict successful defibrillation.


METHODS
VF electrocardiogram (ECG) waveforms stored in ambulance-located defibrillators were collected. Predefibrillation waveforms were divided into 1.0- or 5.12-s VF waveforms. Indices in frequency domain or nonlinear analysis were calculated on the 5.12-s waveform. Simultaneously, CWT was performed on the 1.0-s waveform, and total low-band (1-3 Hz), mid-band (3-10 Hz), and high-band (10-32 Hz) energy were calculated.


RESULTS
In 152 patients with out-of-hospital cardiac arrest, a total of 233 ECG predefibrillation recordings, consisting of 164 unsuccessful and 69 successful episodes, were analyzed. Indices of frequency domain analysis (peak frequency, centroid frequency, and amplitude spectral area), nonlinear analysis (approximate entropy and Hurst exponent, detrended fluctuation analysis), and CWT analysis (mid-band and high-band energy) were significantly different between unsuccessful and successful episodes (P < 0.01 for all). However, logistic regression analysis showed that centroid frequency and total mid-band energy were effective predictors (P < 0.01 for both).


CONCLUSIONS
Energy spectrum analysis based on CWT as short as a 1.0-s VF ECG waveform enables prompt and reliable prediction of successful defibrillation.
Division of Emergency and Critical Care Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahi-machi, Cyuoku, Niigata 951-8510, Japan. endoh@med.niigata-u.ac.jp
Hiroshi
H
Endoh
Seiji
S
Hida
Satomi
S
Oohashi
Yusuke
Y
Hayashi
Hidenori
H
Kinoshita
Tadayuki
T
Honda
D000328:Adult; D000465:Algorithms; D003627:Data Interpretation, Statistical; D004554:Electric Countershock; D004562:Electrocardiography; D019277:Entropy; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D008297:Male; D017711:Nonlinear Dynamics; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D012372:ROC Curve; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*; D058067:Wavelet Analysis