Eiichi Watanabe1, Teruhisa Tanabe2, Motohisa Osaka3, Akiko Chishaki4, Bonpei Takase5, Shinichi Niwano6, Ichiro Watanabe7, Kaoru Sugi8, Takao Katoh9, Kan Takayanagi10, Koushi Mawatari11, Minoru Horie12, Ken Okumura13, Hiroshi Inoue14, Hirotsugu Atarashi15, Iwao Yamaguchi16, Susumu Nagasawa17, Kazuo Moroe18, Itsuo Kodama19, Tsuneaki Sugimoto20, Yoshifusa Aizawa21. 1. Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: enwatan@fujita-hu.ac.jp. 2. Department of Cardiology, Tokai University School of Medicine, Isehara, Japan. 3. Department of Basic Science, Nippon Veterinary and Life Science University, Tokyo, Japan. 4. Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Department of Intensive Care Unit, National Defense Medical College, Tokorozawa, Japan. 6. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan. 7. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 8. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. 9. International University of Health and Welfare, Mita Hospital, Tokyo, Japan. 10. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan. 11. Department of Cardiology, Kagoshima Seikyo Hospital, Kagoshima, Japan. 12. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan. 13. Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 14. Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan. 15. Department of Cardiology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan. 16. Tsukuba University School of Medicine, Tsukuba, Japan. 17. Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. 18. Fukuoka University School of Medicine, Fukuoka, Japan. 19. Nagoya University, Nagoya, Japan. 20. Kanto Central Hospital, Tokyo, Japan. 21. Division of Research and Development, Tachikawa Medical Center, Nagaoka, Japan.
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.
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.
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