Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases.
Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases.
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植入心脏除颤器信号在电和结构疾病患者多形性室性心动过速和颤动自发终止中的独特频谱动力学。
DOI：
10.1093/europace/euac107
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发表时间：
2022
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影响因子：
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通讯作者：
Jalife
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作者：
Calvo,David;Salinas,Lucia;Martínez-Camblor,Pablo;García-Iglesias,Daniel;Alzueta,Javier;Rodríguez,Anibal;Romero,Rafael;Viñolas,Xavier;Fernández-Lozano,Ignacio;Anguera,Ignasi;Villacastín,Julián;Bodegas,Andrés;Fontenla,Adolfo;Jalife
目的探讨人类早期自发多形性室性心动过速/室颤(PVT/VF)的频谱动力学特征。方法与结果应用美敦力心脏除颤器(ICD)对87例各种心脏疾病患者记录的58次自发性PVT/VF和173次电击终止的PVT/VF进行短时快速傅立叶变换，测定其主频(Df)和规律性指数(RI)的动态变化。Df和RI累积强度的级数进一步量化了事件的频谱特征的时间进程。自主终止的室上性心动过速发作持续8.6 S[95%可信区间：8.1~9.1]，休克终止持续13.9 S(13.6~14.3)(P<；0.001)。记录显示，以电病理为主的患者的df和RI值高于以结构病理为主的患者(P<；0.05)，与心功能或抗心律失常药物治疗无关。无论基础病理如何，自止组的平均DF和RI均低于休克终止组[DF：3.67(4.04-4.58)对4.32(3.46-3.93)HZ，P<；0.001；RI：0.53(0.48-0.56)对0.63(0.60-0.65)，P<；0.001]。在由病理类型和临床变量控制的多变量分析中，规律性仍然是自我终止的独立预测因素[风险比：0.954(0.928-0.980)]。受试者工作特征(ROC)曲线分析显示，在约t=8.6 S和t=6.95 S时，95%CI分别高于0.5时的临界值，从而提高了自我终止的可预测性。结论与快速组织信号源维持人的室上性心动过速/室颤的观点一致，频率和规律性的减少与早期自我终止相关。我们的发现可能有助于开发旨在减少不适当电击传递的ICD方法。
AimsTo determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans.Methods and resultsFifty-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 aboutt= 8.6 s andt= 6.95 s, respectively.ConclusionConsistent 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.