Conclusions:
1.The ECG of the onset of induced VF in patients with CAD and BS shows
QRS morphologies that could have their origin in the moderate band of
the right ventricle, the posteromedial papillary muscle and right
ventricle outflow tract.
2. In patients with coronary arterial disease, Wiggers’ tachysystolic
stage of VF could be related to the activation of posterior papillary
muscle and in patients with Brugada, related to activation of RVOT
3. There are no specific fibrillatory structures for every VF etiology.
However there is a predominance of activation in RVOT in Brugada
Syndrome and papillary muscles in ischemic cardiomyopathy.
4. The notches in the sinusoidal traces of ventricular fibrillation
could be a predictor of sustained VF. and in addition notches could also
be the electrocardiographic pattern of activation of essential
structures in the VF maintenance.
Appendice : Method for approach of VF ECG
- Evaluate the first complexes that trigger VF: Triggers
- Delimit a first stage with defined QRS complexes: Tachysystolic stage.
- Define the moment when QRS complexes are not distinguished and
sinusoidal waves appear: Sinusoidal stage.
- Determine the ECG leads in which the sinusoidal waves are low
amplitude with notches.
- Look for QRS complexes between both Tachysystolic and Sinusoidal
stages: Transition complexes.