Olasveengen Theresa M, Eftestøl Trygve, Gundersen Kenneth, Wik Lars, Sunde Kjetil
Institute for Experimental Medical Research and Department of Anaesthesiology, Ulleval University Hospital, N-0407 Oslo, Norway.
Resuscitation. 2009 Apr;80(4):412-7. doi: 10.1016/j.resuscitation.2009.01.012. Epub 2009 Feb 12.
Although ventricular fibrillation waveform characteristics (VFWC) correlate with coronary perfusion pressure and may predict defibrillation outcome, recent animal data indicate that these waveform characteristics are altered in both acute myocardial infarction (AMI) and chronic coronary heart disease (CHD). We wanted to confirm these recent animal data in humans and explore the possibility for such characteristics to identify acute ischemia during cardiac arrest.
Data from all adult patients admitted to hospital after out-of-hospital VF cardiac arrest in Oslo between May 2003 and July 2007 were prospectively collected. Patients were categorized into one of four pre-defined etiologic groups: patients with AMI (AMI only), patients with AMI and CHD (AMI and CHD), patients with previous CHD without evidence for a new AMI (CHD only), and patients with primary arrhythmia (PA). VFWC were analyzed from prehospital ECG tracings, and the different etiologic groups compared using ANOVA.
One-hundred-and-one patients with ECG recordings usable for VF analysis could confidently be categorized; 16 with AMI only, 34 with AMI and CHD, 41 with CHD only and 10 with PA. The two VFWC median slope (MS) and amplitude spectral area (AMSA) were significantly depressed in patients with AMI only compared to both PA (MS p=0.008, AMSA p=0.035) and CHD only patients (MS p=0.008, AMSA p=0.006).
AMI patients have depressed MS and AMSA compared to patients without AMI during VF cardiac arrest. VFWC might be helpful in identifying patients with AMI during cardiac arrest, but prospective clinical studies are warranted to assess its feasibility and clinical benefit.
尽管室颤波形特征（VFWC）与冠状动脉灌注压相关，且可能预测除颤结果，但最近的动物数据表明，这些波形特征在急性心肌梗死（AMI）和慢性冠心病（CHD）中均会发生改变。我们希望在人类中证实这些最新的动物数据，并探索利用这些特征识别心脏骤停期间急性缺血的可能性。
前瞻性收集了2003年5月至2007年7月在奥斯陆因院外室颤心脏骤停入院的所有成年患者的数据。患者被分为四个预先定义的病因组之一：仅患有AMI的患者（仅AMI）、患有AMI和CHD的患者（AMI和CHD）、既往有CHD但无新AMI证据的患者（仅CHD）以及原发性心律失常患者（PA）。从院前心电图记录中分析VFWC，并使用方差分析比较不同病因组。
101例有可用于VF分析的心电图记录的患者能够被明确分类；16例仅患有AMI，34例患有AMI和CHD，41例仅患有CHD，10例患有PA。与PA患者（MS p = 0.008，AMSA p = 0.035）和仅患有CHD的患者（MS p = 0.008，AMSA p = 0.006）相比，仅患有AMI的患者的两个VFWC，即中位斜率（MS）和振幅谱面积（AMSA）显著降低。
在室颤心脏骤停期间，与无AMI的患者相比，AMI患者的MS和AMSA降低。VFWC可能有助于识别心脏骤停期间的AMI患者，但需要进行前瞻性临床研究以评估其可行性和临床益处。
