Correlation Between Defibrillation Shock Outcome and Coherence in Electrocardiograms

Abstract

Cycle periods in ECG during VF are correlated with periods of reentrant activation. The ECGs recorded from different locations on the thorax were contributed to from electrical activations within the heart in approximately inverse proportion of their distance from the recording sites. Similarity in cycle periods between ECGs recorded from two locations, therefore, can be used as an index of spatiotemporal similarity in the rate of activation. In the present study coherence was used, which is a mathematical function that measures the degree of similarity that two signals exhibit at specific cycle periods, to test if spatiotemporal similarity in cycle periods between pairs of orthogonal ECGs was correlated with defibrillation shock outcome. The authors estimated time-varying coherence from orthogonal ECGs during 10 seconds of electrically induced VF, which was terminated with a defibrillation shock with a 50% probability of successful outcome. Defibrillation shocks were delivered between a coil electrode placed at the right ventricular apex and a subdermal patch electrode. Time-varying coherencies between pairs of ECGs were estimated using an adaptive least mean square algorithm. Time-coherence surfaces were integrated within a frequency region centered at the dominant frequency. Data were collected from ten dogs during 206 (48%) successful and 221 (52%) unsuccessful trials. The results showed that coherencies between the sagittal-transverse pair were 10%-15% higher (P < 0.05) for successful than unsuccessful trials. The correlation between coherence and defibrillation outcome suggests that more defibrillation shocks occurred when the degree of spatial similarity in the rate of activations was higher terminated VF, than those that occurred at other times. These results are consistent with a hypothesis, recently proposed by others, that more uniform activation within regions of the heart that receive low potential gradients during shock may increase the probability of successful defibrillation.