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. 2018 Oct;52(5):262-267.
doi: 10.1080/14017431.2018.1494304. Epub 2018 Sep 5.

Ischemic QRS prolongation as a predictor of ventricular fibrillation in a canine model

Jakob Almer  1 , Robert B Jennings  2 , Michael Ringborn  3 , Henrik Engblom  1
Affiliations

Ischemic QRS prolongation as a predictor of ventricular fibrillation in a canine model

Jakob Almer et al. Scand Cardiovasc J. 2018 Oct.

Abstract

Objectives: An acute coronary occlusion and its possible subsequent complications is one of the most common causes of death. One such complication is ventricular fibrillation (VF) due to myocardial ischemia. The severity of ischemia is related to the amount of coronary arterial collateral flow. In dog studies collateral flow has also been shown to be associated with QRS prolongation. The aim of this study was to investigate whether ischemic QRS prolongation (IQP) is associated with impending VF in an experimental acute ischemia dog model.

Methods: Degree of IQP and occurrence of VF were measured in dogs (n = 21) during coronary occlusion for 15 min and also during subsequent reperfusion (experiments conducted in 1984).

Results: There was a significant difference in absolute IQP between dogs which developed VF during reperfusion (47 ± 29 ms, mean ± SD) and those which did not (12 ± 10 ms; p = .001).

Conclusions: IQP during acute coronary occlusion is associated with reperfusion VF in an experimental dog model and might therefore be a potential predictor of malignant arrhythmias in patients with acute coronary syndrome.

Keywords: Ventricular fibrillation; acute coronary syndrome; electrocardiography; ischemia.

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Conflict of interest statement

Disclosure of interest

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.. Depiction of ischemic QRS prolongation measurement method
Depiction of the ischemic QRS prolongation measurement method. During ischemia when no J-point could be clearly distinguished due to ST elevation, a line was drawn through the peak of the R (or R’ if it was present) wave and along 40% of the downslope between the R peak and the nadir of the ST segment. Reprinted from Journal of Electrocardiology, 49/2, Almer et al., Ischemic QRS prolongation as a biomarker of severe myocardial ischemia, 139-147, Copyright (2016), with permission from Elsevier.
Figure 2.
Figure 2.. Relation between VF groups.
Box plot of reperfusion VF and no VF groups.
Figure 3.
Figure 3.. Example ECGs
Example ECG of lead II in two dogs before and at 1, 2, 3 and 4 minutes into occlusion. The dog at the top later develops VF while the one at the bottom does not. The one at the top develops ischemic QRS prolongation during the first minutes of occlusion.
Figure 4.
Figure 4.. ROC curve
ROC curve of IQP indicating VF or not.
See this image and copyright information in PMC

References

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