Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases
Por:
Calvo, D, Salinas, L, Martinez-Camblor, P, Garcia-Iglesias, D, Alzueta, J, Rodriguez, A, Romero, R, Vinolas, X, Fernandez-Lozano, I, Anguera, I, Villacastin, J, Bodegas, A, Fontenla, A, Jalife, J, Berenfeld, O
Publicada:
22 nov 2022
Ahead of Print:
1 jul 2022
Resumen:
Aims To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. Methods and results Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1-9.1] and shock-terminated lasted 13.9 s (13.6-14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04-4.58) vs. 4.32 (3.46-3.93) Hz, P < 0.001; RI: 0.53 (0.48-0.56) vs. 0.63 (0.60-0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928-0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. Conclusion Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.
Filiaciones:
Calvo, D:
Hosp Univ Cent Asturias, Arrhythmia Unit, Avd Roma S-N, Oviedo 33011, Spain
Inst Invest Sanitaria Principado Asturias, Oviedo, Spain
Salinas, L:
Univ Michigan, Ctr Arrhythmia Res, Ann Arbor, MI 48109 USA
Martinez-Camblor, P:
Geisel Med Sch, Dept Biomed Data Sci, Hanover, NH USA
Garcia-Iglesias, D:
Hosp Univ Cent Asturias, Arrhythmia Unit, Avd Roma S-N, Oviedo 33011, Spain
Inst Invest Sanitaria Principado Asturias, Oviedo, Spain
Alzueta, J:
Hosp Virgen de la Victoria, Arrhythmia Unit, Malaga, Spain
Rodriguez, A:
Hosp Univ Canarias, Arrhythmia Unit, Canarias, Spain
Romero, R:
Hosp Univ Ntra Senora Candelaria, Arrhythmia Unit, Canarias, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Arrhythmia Unit, Barcelona, Spain
Fernandez-Lozano, I:
Hosp Puerta de Hierro Majadahonda, Arrhythmia Unit, Madrid, Spain
Anguera, I:
Hosp Bellvitge Princeps Espanya, Arrhythmia Unit, Barcelona, Spain
Villacastin, J:
Hosp Clin San Carlos, Arrhythmia Unit, Madrid, Spain
Bodegas, A:
Hosp Cruces, Arrhythmia Unit, Bilbao, Spain
Fontenla, A:
Hosp 12 Octubre, Arrhythmia Unit, Madrid, Spain
Jalife, J:
Univ Michigan, Ctr Arrhythmia Res, Ann Arbor, MI 48109 USA
Ctr Nacl Invest Cardiovasc CNIC, Cardiac Arrhythmia Lab, Myocardial Pathophysiol Area, Madrid, Spain
CIBER Enfermedades Cardiovasc CIBERCV, Madrid, Spain
Berenfeld, O:
Univ Michigan, Ctr Arrhythmia Res, Ann Arbor, MI 48109 USA
All Open Access; Bronze
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