title: Ventricular fibrillation waveform characteristics of the surface ECG: Impact of the left ventricular diameter and mass.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands. Electronic address: judithbonnes@gmail.com.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bonnes
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Thannhauser
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Joris
authors.initials: J
authors.lastname: Nas
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Sjoerd W
authors.initials: SW
authors.lastname: Westra
authors.affiliation: Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands.
authors.forename: Rutger M G
authors.initials: RMG
authors.lastname: Jansen
authors.affiliation: Faculty of Electrical Engineering, Mathematics and Computer Sciences, Department of Applied Mathematics, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
authors.forename: Gjerrit
authors.initials: G
authors.lastname: Meinsma
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Joep L R M
authors.initials: JLRM
authors.lastname: Smeets
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Wessel
authors.initials: W
authors.lastname: Keuper
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brouwer
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D009929:Organ Size; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
keywords: Electrocardiography; Fourier analysis; Implantable cardioverter defibrillator; Left ventricular diameter; Left ventricular mass; Ventricular fibrillation