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Dominant vector changes during early wavebreak/spiral wave (Wiggers stage 1) in ventricular fibrillation: insights from the analysis of 100 electrophysiology studies

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Abstract

Purpose

To describe electrocardiographic vector patterns during early VF transition (Wiggers stage 1).

Methods

In 100 electrophysiology studies with VF induction, the first 3 beats of VF were analyzed in lead I for left/right axis (LA/RA), V1 for left/right bundle (LB/RB), and aVF for superior/inferior axis (SA/IA). Correlation with demographic/clinical factors was performed using regression analyses and mixed effect modeling.

Results

VF initiated more likely with LA than RA (P < 0.001) and LB than RB (P = 0.04) suggesting original wavebreak in the right ventricle. The 3-dimensional morphology changed in 69% of VF during the first 3 beats, with predominant increase in RB, suggesting a transition of QRS-originating vector to septum/left ventricle. Conservation of morphology (31%) was favored by initial RB (P = 0.002) and LA morphology (P = 0.01). Initiation of VF with LA vs RA was more likely in African-Americans (P = 0.016) and increasing age (P = 0.032). Ischemic cardiomyopathy favored VF initiation with RB 6.7-fold (P = 0.025), possibly linking LV myocardial scar to initial VF wavebreak location. Male gender and ischemic cardiomyopathy prolonged time-to-loss of predominant vector by 119% (P = 0.002) and 71% (P = 0.017), respectively, suggesting more preserved anatomic/functional reentry.

Conclusion

The predominant QRS vectors during early Wiggers stage 1 VF are not random and suggest an initial wavebreak more commonly in the right ventricle, followed by a transitional shift to the septum/left ventricle. Ethnicity, male gender, age, and co-morbidities result in directional preservation of initiating VF vectors possibly due to myocardial mass/fibrosis. Findings may allow new treatment/ablation approaches.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

IA:

Inferior axis

IR:

Incidence rate

LA:

Left axis

LB:

Left bundle

LV:

Left ventricle

EF:

Ejection fraction

NPV:

Negative predictive value

OR:

Odds ratio

OT:

Outflow tract

PPV:

Positive predictive value

PVC:

Premature ventricular complex

RA:

Right axis

RB:

Right bundle

RV:

Right ventricle

SA:

Superior axis

CZ:

Conversion zone

VF:

Ventricular fibrillation

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA

    Mariam Meddeb, Kashif Chaudhry, Saroj Timilsina, Jagat Mahat, Ramarao Vunnam, Aashish Acharya, Alejandro Jimenez Restrepo, Vincent See, Stephen Shorofsky & Timm Dickfeld

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  1. Mariam Meddeb
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  2. Kashif Chaudhry
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  3. Saroj Timilsina
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  4. Jagat Mahat
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Correspondence to Mariam Meddeb.

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Conflict of interest

MM, KC, ST, JM, RV, AA, AJR, VS, and SS declare no relationship with industry. TD declares a General Electric grant and consulting for Biosense, Philips, Abbott, and Impulse dynamics.

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Meddeb, M., Chaudhry, K., Timilsina, S. et al. Dominant vector changes during early wavebreak/spiral wave (Wiggers stage 1) in ventricular fibrillation: insights from the analysis of 100 electrophysiology studies. J Interv Card Electrophysiol 63, 153–164 (2022). https://doi.org/10.1007/s10840-021-00945-9

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