aMplitude spectral area of ventricular fibrillation and amiOdarone Study in patients with out-of-hospital cArdIaC arrest. The MOSAIC study

Francesca Romana Gentile; Lars Wik; Elisabete Aramendi; Enrico Baldi; Iraia Isasi; Jon Erik Steen-Hansen; Sara Compagnoni; Alessandro Fasolino; Enrico Contri; Alessandra Palo; Roberto Primi; Sara Bendotti; Alessia Currao; Simone Savastano

doi:10.3389/fcvm.2023.1179815

aMplitude spectral area of ventricular fibrillation and amiOdarone Study in patients with out-of-hospital cArdIaC arrest. The MOSAIC study

Front Cardiovasc Med. 2023 May 15:10:1179815. doi: 10.3389/fcvm.2023.1179815. eCollection 2023.

Authors

Francesca Romana Gentile^{1

2}, Lars Wik^{3

4}, Elisabete Aramendi⁵, Enrico Baldi¹, Iraia Isasi⁵, Jon Erik Steen-Hansen⁶, Sara Compagnoni^{1

2}, Alessandro Fasolino^{1

2}, Enrico Contri⁷, Alessandra Palo⁷, Roberto Primi¹, Sara Bendotti¹, Alessia Currao¹, Simone Savastano¹

Affiliations

¹ Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
² Department of Molecular Medicine, University of Pavia, Pavia, Italy.
³ Oslo University Hospital, Division of Prehospital Emergency Medicine, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway.
⁴ Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway.
⁵ BioRes Group, University of the Basque Country, Bilbao, Spain.
⁶ Division of Prehospital Care, Vestfold Hospital Trust, Tønsberg, Norway.
⁷ AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Abstract

Objective: Antiarrhythmic drugs are recommended for out of hospital cardiac arrest (OHCA) with shock-refractory ventricular fibrillation (VF). Amplitude Spectral Area (AMSA) of VF is a quantitative waveform measure that describes the amplitude-weighted mean frequency of VF, it correlates with intramyocardial adenosine triphosphate (ATP) concentration, it is a predictor of shock efficacy and an emerging indicator to guide defibrillation and resuscitation efforts. How AMSA might be influenced by amiodarone administration is unknown.

Methods: In this international multicentre observational study, all OHCAs receiving at least one shock were included. AMSA values were calculated by retrospectively analysing the pre-shock ECG interval of 2 s. Multivariable models were run and a propensity score based on the probability of receiving amiodarone was created to compare two randomly matched samples.

Results: 2,077 shocks were included: 1,407 in the amiodarone group and 670 in the non-amiodarone group. AMSA values were lower in the amiodarone group [8.8 (6-12.7) mV·Hz vs. 9.8 (6-14) mV·Hz, p = 0.035]. In two randomly matched propensity score-based groups of 261 shocks, AMSA was lower in the amiodarone group [8.2 (5.8-13.5) mV·Hz vs. 9.6 (5.6-11.6), p = 0.042]. AMSA was a predictor of shock success in both groups but the predictive power was lower in the amiodarone group [Area Under the Curve (AUC) non-amiodarone group 0.812, 95%CI: 0.78-0.841 vs. AUC amiodarone group 0.706, 95%CI: 0.68-0.73; p < 0.001].

Conclusions: Amiodarone administration was independently associated with the probability of recording lower values of AMSA. In patients who have received amiodarone during cardiac arrest the predictive value of AMSA for shock success is significantly lower, but still statistically significant.

Keywords: AMSA; amidoarone; cardiac arrest; defibrillation; ventricular fibrillation.

Grants and funding

This work was partially supported by the Spanish Ministerio de Ciencia, Innovación y Universidades under Grant RTI2018-101475-BI00, jointly with the Fondo Europeo de Desarrollo Regional (FEDER); by the Basque Government under Grant IT-1717-22; and by the University of the Basque Country (UPV/EHU) under Grant COLAB20/01. The Lombardia CARe is one of the research projects of the Fondazione IRCCS Policlinico San Matteo (Pavia) and it is partially funded by the Fondazione Banca del Monte di Lombardia.