Synchronized defibrillation for ventricular fibrillation.

Objective: Optimization of defibrillation success is important to improve efficacy and minimize post-shock sequelae. Previous work has suggested an improvement in shock success when an intracardiac shock is delivered synchronized to the upslope of a VF wave. We investigated the efficacy of transthoracic defibrillation success using a novel external biphasic defibrillator which delivers shocks synchronized to the upslope of the surface ECG.

Detection of cardiac arrest using a simplified frequency analysis of the impedance cardiogram recorded from defibrillator pads.

An algorithm based only on the impedance cardiogram (ICG) recorded through two defibrillation pads, using the strongest frequency component and amplitude, incorporated into a defibrillator could determine circulatory arrest and reduce delays in starting cardiopulmonary resuscitation (CPR). Frequency analysis of the ICG signal is carried out by integer filters on a sample by sample basis. They are simpler, lighter and more versatile when compared to the FFT.

Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction.

Background: For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI).

The inverse problem utilizing the boundary element method for a nonstandard female torso.

This paper proposes a new method of rapidly deriving the transfer matrix for the boundary element method (BEM) forward problem from a tailored female torso geometry in the clinical setting. The method allows rapid calculation of epicardial potentials (EP) from body surface potentials (BSP). The use of EPs in previous studies has been shown to improve the successful detection of the life-threatening cardiac condition--acute myocardial infarction.

Assessment of the impedance cardiogram recorded by an automated external defibrillator during clinical cardiac arrest.

Objective: To assess the impedance cardiogram recorded by an automated external defibrillator during cardiac arrest to facilitate emergency care by lay persons. Lay persons are poor at emergency pulse checks (sensitivity 84%, specificity 36%); guidelines recommend they should not be performed. The impedance cardiogram (dZ/dt) is used to indicate stroke volume.

Changes in the frequency spectrum, the P-P interval, and the bispectral index during ventricular fibrillation are physiologic indicators of ventricular fibrillation duration.

The 3-phase time-sensitive model by Weisfeldt and Becker in 2002 has resulted in a redirection of efforts toward developing treatment algorithms specific to each phase of cardiac arrest. In this study, a number of physiologic indicators of ventricular fibrillation (VF) duration were investigated. The bispectral index was recorded at 15-second intervals over 12 minutes and recordings of the atrial electrocardiogram and lead II electrocardiogram were acquired simultaneously using Notocord data acquisition software during sinus rhythm, ventricular tachycardia, and VF, and analyzed using a total of 30 porcine models.

An early phase of slow myocardial activation may be necessary in order to benefit from cardiac resynchronization therapy.

Background: Not all patients with a QRS duration longer than 140 milliseconds respond to cardiac resynchronization therapy (CRT). The same QRS duration may correspond to different spatiotemporal patterns of myocardial activation that influence response to CRT.

Methods: Electrocardiographic imaging based on 80 chest wall electrodes was used to construct the spatiotemporal myocardial activation map in 46 consecutive patients before CRT.

Activation patterns during selective pacing of the left ventricle can be characterized using noninvasive electrocardiographic imaging.

Background: Noncontact endocardial mapping allows accurate beat-to-beat reconstruction of the reentrant pathway of ventricular tachycardia and improves outcomes after ablation. Several studies support electrocardiographic imaging (ECGI) as a means of noninvasively outlining epicardial activation despite constraints of internal geometry. However, few have explored its clinical application.

Usefulness of body surface maps to demonstrate ventricular activation patterns during left ventricular pacing and reentrant activation during ventricular tachycardia in men with coronary heart disease and left ventricular dysfunction.

Epicardial electrical events were reconstructed using an inverse model for left ventricular (LV) pacing and during ventricular tachycardia (VT) induced during implantation of a biventricular pacemaker and/or internal defibrillator. The electrocardiographic position of the pacing lead, determined from the region of most negative potential 30 ms after the pacing spike, was compared with the radiographic position. Activation characterized by isochronal maps was correlated with the echocardiographic/myocardial scintigraphic data.

Improved detection of acute myocardial infarction using a diagnostic algorithm based on calculated epicardial potentials.

Background: New methods for detecting myocardial infarction in patients with suspected acute coronary syndromes are needed particularly in an era where the majority of patients with myocardial infarction present with non-diagnostic 12-lead electrocardiograms (ECG). We compared a novel epicardial diagnostic algorithm using epicardial potentials from the 80-lead body surface map with other electrocardiographic techniques in detection of myocardial infarction.

Methods: Between February 1999 and February 2001, consecutive patients (n=427) with ischemic type chest pain had an initial 12-lead ECG and body surface map recorded.

The use of calculated epicardial potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction.

Inverse electrocardiography can calculate epicardial potentials (EP) from body surface potentials (BSP) taking into account a thoracic volume conductor model (TVCM). Previous studies have shown that a tailored TVCM is superior to a general TVCM in calculating EP. However, construction of a tailored TVCM for a patient in an acute clinical setting is impractical.