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Editorial| Volume 151, P205-207, June 2020

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The drugs don’t matter: Cardiovascular drugs have minimal effects on amplitude spectral area during ventricular fibrillation

      Successful return of spontaneous circulation (ROSC) after out of hospital cardiac arrest (OHCA) continues to depend on the ability to defibrillate the heart out of ventricular fibrillation (VF).
      • Neumar R.W.
      • Otto C.W.
      • Link M.S.
      • et al.
      Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
      Despite significant advances in signal processing technology and resuscitation care, it remains difficult to accurately characterize ventricular fibrillation and to successfully terminate VF. As demonstrated previously, the waveform characteristics of VF can be altered by both the underlying pathology and by medications commonly used by patients at risk for cardiac arrest.
      • Sherman L.
      • Niemann J.
      • Youngquist S.T.
      • Shah A.P.
      • Rosborough J.P.
      Beta-blockade causes a reduction in the frequency spectrum of VF but improves resuscitation outcome: a potential limitation of quantitative waveform measures.
      • Marshall G.E.
      • Russell J.A.
      • Tellez J.O.
      • et al.
      Remodelling of human atrial K+ currents but not ion channel expression by chronic β-blockade.
      • Chiamvimonvat N.
      • Chen-Izu Y.
      • Clancy C.E.
      • et al.
      Potassium currents in the heart: functional roles in repolarization, arrhythmia and therapeutics.
      Any attempts to use quantitative ventricular fibrillation waveform characteristics, such as amplitude spectral area (AMSA), to predict a given patients chance of ROSC after defibrillation, will require understanding the link between cardiac pathology, medication use, and waveform morphology.
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      References

        • Neumar R.W.
        • Otto C.W.
        • Link M.S.
        • et al.
        Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2010; 122: S729-S767https://doi.org/10.1161/CIRCULATIONAHA.110.970988
        • Sherman L.
        • Niemann J.
        • Youngquist S.T.
        • Shah A.P.
        • Rosborough J.P.
        Beta-blockade causes a reduction in the frequency spectrum of VF but improves resuscitation outcome: a potential limitation of quantitative waveform measures.
        Resuscitation. 2012; 83: 511-516https://doi.org/10.1016/j.resuscitation.2011.09.026
        • Marshall G.E.
        • Russell J.A.
        • Tellez J.O.
        • et al.
        Remodelling of human atrial K+ currents but not ion channel expression by chronic β-blockade.
        Pflugers Arch Eur J Physiol. 2012; 463: 537-548https://doi.org/10.1007/s00424-011-1061-z
        • Chiamvimonvat N.
        • Chen-Izu Y.
        • Clancy C.E.
        • et al.
        Potassium currents in the heart: functional roles in repolarization, arrhythmia and therapeutics.
        J Physiol. 2017; 595: 2229-2252https://doi.org/10.1113/JP272883
        • Hulleman M.
        • Salcido D.D.
        • Menegazzi J.J.
        • et al.
        Ventricular fibrillation waveform characteristics in out-of-hospital cardiac arrest and cardiovascular medication use.
        Resuscitation. 2020; 151: 173-180https://doi.org/10.1016/j.resuscitation.2020.02.027
        • Indik J.H.
        • Conover Z.
        • McGovern M.
        • et al.
        Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest.
        J Am Coll Cardiol. 2014; 64: 1362-1369https://doi.org/10.1016/j.jacc.2014.06.1196
        • Ristagno G.
        • Li Y.
        • Fumagalli F.
        • Finzi A.
        • Quan W.
        Amplitude spectrum area to guide resuscitation – a retrospective analysis during out-of-hospital cardiopulmonary resuscitation in 609 patients with ventricular fibrillation cardiac arrest.
        Resuscitation. 2013; 84: 1697-1703
        • Ristagno G.
        • Mauri T.
        • Cesana G.
        • et al.
        Amplitude spectrum area to guide defibrillation: a validation on 1617 ventricular fibrillation patients.
        Circulation. 2015; 131: 478-487
        • Fumagalli F.
        • Ristagno G.
        • Russo I.
        • Staszewsky L.
        • Latini R.
        • Li Y.
        Abstract 137: Ranolazine increases amplitude spectrum area during untreated ventricular fibrillation and cardiopulmonary resuscitation.
        Circulation. 2013; 128 (A137)https://doi.org/10.1161/circ.128.suppl_22.A137
        • Noujaim S.F.
        • Pandit S.V.
        • Berenfeld O.
        • et al.
        Up-regulation of the inward rectifier K+ current (IK1) in the mouse heart accelerates and stabilizes rotors.
        J Physiol. 2007; 578: 315-326https://doi.org/10.1113/jphysiol.2006.121475
        • Farid T.A.
        • Nair K.
        • Massé S.
        • et al.
        Role of KATP channels in the maintenance of ventricular fibrillation in cardiomyopathic human hearts.
        Circ Res. 2011; 109: 1309-1318https://doi.org/10.1161/CIRCRESAHA.110.232918
        • Dorian P.
        • Penkoske P.A.
        • Witkowski F.X.
        Order in disorder: effect of barium on ventricular fibrillation.
        Can J Cardiol. 1996; 12: 399-406
        • Tamariz L.
        • Harkins T.
        • Nair V.
        A systematic review of validated methods for identifying ventricular arrhythmias using administrative and claims data.
        Pharmacoepidemiol Drug Saf. 2012; 21: 148-153https://doi.org/10.1002/pds.2340
        • Hashimoto R.
        • Brodt E.
        • Skelly A.
        • Dettori J.
        Administrative database studies: goldmine or goose chase?.
        Evid Based Spine Care J. 2014; 5: 074-076https://doi.org/10.1055/s-0034-1390027
        • Sasson C.
        • Rogers M.A.M.
        • Dahl J.
        • Kellermann A.L.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
        • Wiggers C.J.
        • Bell J.R.
        • Paine M.
        Studies of ventricular fibrillation caused by electric shock: II. Cinematographic and electrocardiographic observations of the natural process in the dog's heart. Its inhibition by potassium and the revival of coordinated beats by calcium.
        Ann Noninvasive Electrocardiol. 2003; 8: 252-261https://doi.org/10.1046/j.1542-474X. 2003.08316.x
        • Povoas H.P.
        • Bisera J.
        Electrocardiographic waveform analysis for predicting the success of defibrillation.
        Crit Care Med. 2000; : 28https://doi.org/10.1097/00003246-200011001-00010
        • Wltkowskl F.X.
        • Leon L.J.
        • Penkoske P.A.
        • et al.
        Spatiotemporal evolution of ventricular fibrillation.
        Nature. 1998; 392: 78-82https://doi.org/10.1038/32170
        • Coult J.
        • Blackwood J.
        • Sherman L.
        • Rea T.D.
        • Kudenchuk P.J.
        • Kwok H.
        Ventricular fibrillation waveform analysis during chest compressions to predict survival from cardiac arrest.
        Circ Arrhythmia Electrophysiol. 2019; 12: e006924https://doi.org/10.1161/CIRCEP.118.006924
        • Aiello S.
        • Perez M.
        • Cogan C.
        • et al.
        Real-time ventricular fibrillation amplitude-spectral area analysis to guide timing of shock delivery improves defibrillation efficacy during cardiopulmonary resuscitation in swine.
        J Am Heart Assoc. 2017; : 6https://doi.org/10.1161/JAHA.117.006749
        • He M.
        • Lu Y.
        • Zhang L.
        • Zhang H.
        • Gong Y.
        • Li Y.
        Combining amplitude spectrum area with previous shock information using neural networks improves prediction performance of defibrillation outcome for subsequent shocks in out-of-hospital cardiac arrest patients.
        PLOS ONE. 2016; : 11https://doi.org/10.1371/journal.pone.0149115
        • Indik J.H.
        • Donnerstein R.L.
        • Hilwig R.W.
        • et al.
        The influence of myocardial substrate on ventricular fibrillation waveform: a swine model of acute and postmyocardial infarction.
        Crit Care Med. 2008; 36: 2136-2142https://doi.org/10.1097/CCM.0b013e31817798c
        • Massé S.
        • Farid T.
        • Dorian P.
        • et al.
        Effect of global ischemia and reperfusion during ventricular fibrillation in myopathic human hearts.
        Am J Physiol – Hear Circ Physiol. 2009; 297: H1984-H1991https://doi.org/10.1152/ajpheart.00101.2009
        • Achleitner U.
        • Wenzel V.
        • Strohmenger H.U.
        • et al.
        The beneficial effect of basic life support on ventricular fibrillation mean frequency and coronary perfusion pressure.
        Resuscitation. 2001; 51: 151-158https://doi.org/10.1016/s0300-9572(01)00388-4
        • Kern K.B.
        • Garewal H.S.
        • Sanders A.B.
        • et al.
        Depletion of myocardial adenosine triphosphate during prolonged untreated ventricular fibrillation: effect on defibrillation success.
        Resuscitation. 1990; 20: 221-229https://doi.org/10.1016/0300-9572(90)90005-y
        • Yang Q.
        • Li M.
        • Huang Z.
        • et al.
        Validation of spectral energy for the quantitative analysis of ventricular fibrillation waveform to guide defibrillation in a porcine model of cardiac arrest and resuscitation.
        J Thorac Dis. 2019; 11: 3853-3863https://doi.org/10.21037/jtd.2019.09.18