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Sudden cardiac arrest recorded during Holter monitoring: prevalence, antecedent electrical events, and outcomes.

Abstract：

BACKGROUND:Causative arrhythmias of sudden cardiac arrest (SCA) are changing in this age of improved coronary care. OBJECTIVE:The purpose of this study was to examine the frequency of terminal arrhythmias and the electrical events prior to SCA. METHODS:We analyzed 24-hour Holter recordings of 132 patients enrolled from 41 institutions who either died (n = 88) or had an aborted death (n = 44). The Holter recordings were obtained for diagnosing and evaluating diseases and arrhythmias in those without any episodes suggestive of SCA. RESULTS:In 97 patients (73%), SCA was associated with ventricular tachyarrhythmias and in 35 (27%) with bradyarrhythmias. The bradyarrhythmia-related SCA patients were older than those with a tachyarrhythmia-related SCA (70 ± 13 years vs. 58 ± 19 years, P < .001). The most common arrhythmia for a tachyarrhythmia-related SCA was ventricular tachycardia degenerating to ventricular fibrillation (45%). The bradyarrhythmia-related SCA was caused by asystole (74%) or AV block (26%). Spontaneous conversion was observed in 37 patients (38%) with ventricular tachyarrhythmias. Of those, 62% of the patients experienced symptoms including syncope, chest pain, or convulsion. Multivariate logistic analysis revealed that independent predictors of mortality for tachyarrhythmia-related SCAs were advanced age (odds ratio 1.04, 95% confidence interval 1.02-1.08) and ST elevation within the hour before SCA (odds ratio 3.54, 95% confidence interval 1.07-13.5). In contrast, the presence of preceding torsades de pointes was associated with spontaneous conversion (odds ratio 0.20, 95% confidence interval 0.05-0.66). CONCLUSION:The most frequent cause of SCA remains ventricular tachyarrhythmias. Advanced age and ST elevation before SCA are risk factors for mortality in tachyarrhythmia-related SCAs.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Watanabe E,Tanabe T,Osaka M,Chishaki A,Takase B,Niwano S,Watanabe I,Sugi K,Katoh T,Takayanagi K,Mawatari K,Horie M,Okumura K,Inoue H,Atarashi H,Yamaguchi I,Nagasawa S,Moroe K,Kodama I,Sugimoto T,Aizawa Y

doi

10.1016/j.hrthm.2014.04.036

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

1418-25

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(14)00498-6

journal_volume

pub_type

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Sudden cardiac arrest recorded during Holter monitoring: prevalence, antecedent electrical events, and outcomes.