Bonnes, Judith L.

Brouwer, Marc A.

de Boer, M.J.

Grunsven, P.M.

Keuper, W.

Meinsma, G.

Nas, J.

Smeets, J.L.R.M.

Starreveld, R.

Thannhauser, J.

van Royen, N.

Zwart, H.J.

English

NARCIS 

Acute coronary occlusion in the out-of-hospital cardiac arrest setting: impact on VF-waveform

University of Twente Research Information

Ventricular arrhythmias and sudden cardiac death – Diagnostic methods 1023(28,0%) or ventricular (23,9%) arrhythmias. Analyzing the follow ups, we foundthat older athletes had higher complexity and prevalence of arrhythmias, whereasyounger people had higher frequency of arrhythmias in the 24h recordings. Ar-rhythmic peaks in each of the three age groups were found respectively at 14±2years, 24±4,5 years and 58±11,1 yrs. These findings lead us to say that in sportspopulation arrhythmias are a common event and they are often compatible withsports practice.P4848Acute coronary occlusion in the out-of-hospital cardiac arrest setting:impact on VF-waveformJ. Nas, J. Thannhauser, R. Starreveld, W. Keuper, P.M. Van Grunsven,G. Meinsma, J.L.R.M. Smeets, H.J. Zwart, N. Van Royen, M.J. De Boer,J.L. Bonnes, M.A. Brouwer. Radboud University Medical Centre, Cardiology,Nijmegen, NetherlandsBackground: In many cardiac arrest patients, an acute coronary occlusion (ACO)is the underlying cause of ventricular fibrillation (VF). Driven by its strong associ-ation with arrest duration, low frequency-low amplitude VF has become an estab-lished marker of poor prognosis. In addition to the impact of time, animal studieshave suggested that an ACO also results in low frequency-low amplitude VF. Ifproven in humans, currently studied “smart defibrillators” may require adjustedalgorithms to better guide treatment and prognosis.Aim: In human cardiac arrest patients, we aim to investigate whether an ACOresults in low frequency-low amplitude VF.Methods: Cohort study of VF patients admitted at a tertiary care university hos-pital. A clinical panel reviewed underlying aetiology and infarct criteria. Amplitude,frequency and AMSA (Amplitude spectrum area, see Figure) were calculated ofthe first observed VF-segment on the paddle-ECG (recording direction ∼ surfaceECG lead II).Results: Patients with an ACO (n=62) had significantly lower AMSA, amplitudeand frequency-related VF characteristics compared to patients without an under-lying ACO (n=40, p<0.05 for all VF-characteristics). Analyses on infarct locali-sation (anterior, inferior) showed the lowest amplitude characteristics in paddlerecordings of an inferior ACO. Differences were independent of ambulance re-sponse times.VF waveform measures in relation to ACOConclusions: In analogy to animal studies, an acute coronary occlusion led toa lower VF-waveform as compared to patients without coronary occlusion. Ourfindings imply that the VF-waveform cannot be simply considered a proxy for time,and that recording direction may as well be a future subject of study in the devel-opment of “smart” defibrillators.P4849Man vs. machine: comparison of manual vs. automated 12-lead ECGprediction of the origin of idiopathic ventricular arrhythmias to guidecatheter ablationR. Ebrahimi1, I. Strebel1, P.M. Van Dam2, M. Kuehne1, S. Knecht1, F. Spies1,R. Abaecherli1, P. Badertscher1, N. Kozhuharov1, I. Zeljkovic1, B. Schaer1,S. Osswald1, C. Sticherling1, T. Reichlin1. 1University Hospital Basel, Basel,Switzerland; 2Radboud University Medical Centre, Nijmegen, NetherlandsIntroduction: Catheter ablation of frequent idiopathic ventricular arrhythmias(VA) is increasingly performed. While the right ventricular outflow tract (RVOT)has traditionally been the most frequent ablation site, targeting sites also in theleft ventricle (LV) has increased over the past years. Preprocedural prediction ofthe arrhythmia origin from the 12-lead ECG is critical for informed consent and toguide the invasive mapping procedure. Preprocedural prediction however is lim-ited by inter-individual variation in lead position and the orientation of the heartin the chest. In this study, we aimed to prospectively assess the performance ofmanual vs. automated 12-lead ECG analysis in the prediction of VA origin in theRV as opposed to the LV.Methods: In a prospective observational cohort study, consecutive patients un-dergoing catheter ablation of idiopathic VA were enrolled. The VA origin was de-fined as the site where ablation caused arrhythmia suppression. Patients wereexcluded if ablation was unsuccessful. A digital 12-lead ECG was recorded atadmission for documentation of the VA. All baseline ECG’s were analyzed man-ually by 3 electrophysiologists and 3 EP fellows in a blinded fashion guided by apreviously published ECG algorithm. Similarly, all 12-lead ECG’s were analyzedin a blinded fashion using a recently developed fully automated ECG algorithm(Figure). The novel algorithm assumed standard body build and lead placement.Results: A total of 54 patients were enrolled. Median age was 48 years (IQR 37–61) and 59% of the patients were female. The VA origin was found in the RV in 33patients (61%) and in the LV in 21 patients (39%). The automated 12-lead ECGalgorithm successfully identified the VA origin in 76% of the patients, which wassimilar compared to manual ECG analysis performed by the electrophysiologists(median 76%, range 74–80%) and the EP-fellows (median 76%, range 74–78%).Conclusion: An automated 12-lead ECG algorithm successfully predicts the ori-gin of idiopathic VA in the RV or LV with a similar accuracy as manual expert anal-ysis guided by a previously published ECG algorithm. The accuracy of both man-ual and automated analysis is limited to 76%, most likely due to inter-individualvariation of precordial electrode positions and of the orientation of the heart. In-tegration of the patient-specific electrode positions obtained with 3D photographymight further improve the performance of the automated analysis.P4850Variability in the diagnosis of Brugada syndromeM. Plessis1, F. Sacher2, N. Behar3, P. Mabo3, B. Belhassen4, M.J. Ackerman5,E. Schulze-Bahr6, S. Viskin4, V. Probst1, J.B. Gourraud1. 1University Hospital ofNantes, Thorax Institute, Nantes, France; 2University Hospital of Bordeaux,Bordeaux, France; 3University Hospital of Rennes, Rennes, France; 4Tel AvivSourasky Medical Center, Tel Aviv, Israel; 5Mayo Clinic, Rochester, UnitedStates of America; 6University Hospital of Munster, Munster, GermanyAims: Brugada syndrome (BrS) is diagnosed in the presence of a type 1 ECGpattern on ECG. Based on only one study, the definition of this ECG pattern hasbeen enlarged in last guidelines.Objective: We aim to investigate the impact of this modification in borderlinecases.Methods: Data of consecutives patients referred for BrS to the Nantes Universi-tary Hospital were reviewed by 2 physicians, blinded to the clinical and geneticalstatus. The first 6 cases of disagreement were presented to 30 residents trainedfor BrS diagnosis, 154 cardiologist and 5 European Expert in inherited arrhyth-mia. Number of ECG leads presenting a type 1 ECG pattern, requirement of asodium channel blocker challenge and indication of ICD implantation were askedfor each patients.Results: Only 58 (38%) general cardiologist but all residents and all expert an-swer the study. Among those three groups, nor diagnosis, neither number of ECGleads presenting a type 1 ECG pattern, requirement of a sodium channel blockerchallenge or indication for ICD implantation was correlated (r2 <0.5). Interest-ingly this variability was also observed in each group. The main difficulty was thenumber of lead presenting a spontaneous type 1 ECG. This led to modify ICDindication in more than 50% of patient even in the expert group.Conclusion: We demonstrated a huge variability in the interpretation of ECG ofBrs patients. This variability lead to variation in the diagnosis and the risk stratifi-cation that emphasizes the extreme cautious needed in the interpretation of suchECG.P4851Catheter ablation of electrical storm: a single center experienceS. Garkina, R. Tatarsky, E. Mikhaylov, V. Lebedeva, V. Orshanskaya, Y.U. Miller,M. Naymushin, A. Kamenev, S. Nemtzov, S. Gureev, D. Lebedev. AlmazovNational Medical Research Centre, Saint-Petersburg, Russian FederationBackground: Electrical storm (ES) is a life threating situation. It is defined as3 or more sustained episodes of ventricular tachycardia (VT), ventricular fibrilla-tion (VF) or appropriate implantable cardioverter-defibrillator (ICD) shocks during24 hours. Several clinical studies demonstrated the rate of ES about 9–12% af-ter ICD implantation due to both primary and secondary prevention while 7% ofpatients developed it during first year of follow up. Radiofrequency (RF) ablationof triggering ventricular premature beats or substrate-based catheter treatmentDownloaded from https://academic.oup.com/eurheartj/article-abstract/39/suppl_1/ehy563.P4848/5083759 by guest on 01 November 2018

Acute coronary occlusion in the out-of-hospital cardiac arrest setting:impact on VF-waveform

Acute coronary occlusion in the out-of-hospital cardiac arrest setting:impact on VF-waveform

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