Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation

Abstract

AimsRecent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown.Methods and resultsData were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80–22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12–12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively.ConclusionOur findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.

Mapping and Ablation of Idiopathic Ventricular Fibrillation

“…Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac death (SCD). It is reported in 6.8% of all patients who survive an out-of-hospital cardiac arrest and is more frequent in young adults ( 1 ). Indeed up to 35% of cases of sudden death remain unexplained in patients between 18 and 35 years old ( 2 ).…”

Czy jest możliwa automatyczna interpretacja EKG za pomocą zdjęcia wykonanego smartfonem?

“…"Ręczna" ocena zapisu EKG przeprowadzona przez badacza uniemożliwia wykorzystanie nowoczesnych metod uczenia maszynowego, które mogłyby analizować zapis EKG i relacje między poszczególnymi elementami krzywej. Być może, jest to jedna z przyczyn niepowodzeń w poszukiwaniach cech zapisu EKG swoistych dla zwiększonego ryzyka nagłej śmierci sercowej [16].…”

Vasospasm-Related Sudden Cardiac Death Has Outcomes Comparable with Coronary Stenosis in Out-of-Hospital Cardiac Arrest

“…Coronary artery disease accounts for approximately 80% of sudden cardiac arrest (SCA). 1,2 Of the coronary artery diseases, acute coronary syndrome with coronary stenosis due to atherosclerosis is principally related to SCA, while SCA related to coronary vasospasm is a minority. 2 However, the Asian population has high incidence of variant angina or SCA related to coronary vasospasm, 3-5 because they have a diffuse coronary vasomotor reactivity as compared to Caucasians.…”