Assessment and follow-up of pediatric survivors of sudden cardiac death.

Abstract

In the young patient resuscitated from sudden cardiac arrest, the risks of recurrence are uncertain and so are the criteria defining therapeutic efficacy for the presumed cause of the initial event. In this study, we analyzed the outcome of 15 consecutive young patients, who were resuscitated from pulseless ventricular tachycardia or ventricular fibrillation and who were evaluated by comprehensive hemodynamic and electrophysiological testing. Patients were 11.2 ±2.7 (mean± SD) years old at the time of their event, and each was known to have some form of heart disease before sudden cardiac arrest. Ventricular tachycardia or fibrillation was inducible by programmed electrical stimulation in eight patients. Accessory atrioventricular connections, with antegrade effective refractory periods less than 220 msec, were identified in three patients. Sustained atrial flutter was the only arrhythmia inducible in two patients, and no arrhythmias were inducible in two other patients. Surgical or electrophysiological-guided medical therapy resulted in noninducibility of the ventricular arrhythmias in six patients.

Cardiac Syncope in Pediatric Patients

“…18 This group of arrhythmias also comprises most of the diagnoses made after resuscitation from out-of-hospital cardiac arrest. 19 Supraventricular tachycardia may lead to syncope, but rarely to sudden death in children with a structurally normal heart. Syncope in children can result from a wide variety of causes.…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…The prevalence of ventricular ectopy decreases to less than 5% in children but then increases to 10% by 10 y of age and 25% during late adolescence and early adulthood (994 -996). For the vast majority of young patients with ventricular ectopy, the primary objective is to exclude any associated functional or structural heart disease, in which case PVCs may have prognostic significance (434,997). Simple ventricular ectopy in the absence of heart disease has not been demonstrated to have adverse prognostic significance.…”

Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests

“…It is also important to note that the myocardium of younger children and neonates appears to be more susceptible to ischemia than adult cardiac tissue and is less likely to sustain VF even when healthy. [28][29][30][31] As younger children have an increased proportion of unwitnessed arrests, and therefore a greater likelihood of prolonged time from arrest to initiation of resuscitation, they are more likely to have greater rhythm degradation prior to intervention.…”