1
|
Hautamäki M, Järvensivu-Koivunen M, Lyytikäinen LP, Eskola M, Lehtimäki T, Nikus K, Oksala N, Tynkkynen J, Hernesniemi J. The association between GRACE score at admission for myocardial infarction and the incidence of sudden cardiac arrests in long-term follow-up - the MADDEC study. SCAND CARDIOVASC J 2024; 58:2335905. [PMID: 38557164 DOI: 10.1080/14017431.2024.2335905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Background. Sudden cardiac arrest (SCA), often also leading to sudden cardiac death (SCD), is a common complication in coronary artery disease. Despite the effort there is a lack of applicable prediction tools to identify those at high risk. We tested the association between the validated GRACE score and the incidence of SCA after myocardial infarction. Material and methods. A retrospective analysis of 1,985 patients treated for myocardial infarction (MI) between January 1st 2015 and December 31st 2018 and followed until the 31st of December of 2021. The main exposure variable was patients' GRACE score at the point of admission and main outcome variable was incident SCA after hospitalization. Their association was analyzed by subdistribution hazard (SDH) model analysis. The secondary endpoints included SCA in patients with no indication to implantable cardioverter-defibrillator (ICD) device and incident SCD. Results. A total of 1985 patients were treated for MI. Mean GRACE score at baseline was 118.7 (SD 32.0). During a median follow-up time of 5.3 years (IQR 3.8-6.1 years) 78 SCA events and 52 SCDs occurred. In unadjusted analyses one SD increase in GRACE score associated with over 50% higher risk of SCA (SDH 1.55, 95% CI 1.29-1.85, p < 0.0001) and over 40% higher risk for SCD (1.42, 1.12-1.79, p = 0.0033). The associations between SCA and GRACE remained statistically significant even with patients without indication for ICD device (1.57, 1.30-1.90, p < 0.0001) as well as when adjusting with patients LVEF and omitting the age from the GRACE score to better represent the severity of the cardiac event. The association of GRACE and SCD turned statistically insignificant when adjusting with LVEF. Conclusions. GRACE score measured at admission for MI associates with long-term risk for SCA.
Collapse
Affiliation(s)
- Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juho Tynkkynen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
- Finnish Cardiovascular Research Center-Tampere, Tampere, Finland
| |
Collapse
|
2
|
Verheul LM, Groeneveld SA, Stoks J, Hoeksema WF, Cluitmans MJM, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. The Dutch Idiopathic Ventricular Fibrillation Registry: progress report on the quest to identify the unidentifiable. Neth Heart J 2024:10.1007/s12471-024-01870-y. [PMID: 38653923 DOI: 10.1007/s12471-024-01870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Idiopathic ventricular fibrillation (iVF) is a rare cause of sudden cardiac arrest and, by definition, a diagnosis of exclusion. Due to the rarity of the disease, previous and current studies are limited by their retrospective design and small patient numbers. Even though the incidence of iVF has declined owing to the identification of new disease entities, an important subgroup of patients remains. AIM To expand the existing Dutch iVF Registry into a large nationwide cohort of patients initially diagnosed with iVF, to reveal the underlying cause of iVF in these patients, and to improve arrhythmia management. METHODS The Dutch iVF Registry includes sudden cardiac arrest survivors with an initial diagnosis of iVF. Clinical data and outcomes are collected. Outcomes include subsequent detection of a diagnosis other than 'idiopathic', arrhythmia recurrence and death. Non-invasive electrocardiographic imaging is used to investigate electropathological substrates and triggers of VF. RESULTS To date, 432 patients have been included in the registry (median age at event 40 years (interquartile range 28-52)), 61% male. During a median follow-up of 6 (2-12) years, 38 patients (9%) received a diagnosis other than 'idiopathic'. Eleven iVF patients were characterised with electrocardiographic imaging. CONCLUSION The Dutch iVF Registry is currently the largest of its kind worldwide. In this heterogeneous population of index patients, we aim to identify common functional denominators associated with iVF. With the implementation of non-invasive electrocardiographic imaging and other diagnostic modalities (e.g. echocardiographic deformation, cardiac magnetic resonance), we advance the possibilities to reveal pro-fibrillatory substrates.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Job Stoks
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wiert F Hoeksema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
3
|
Weizman O, Gandjbakhch E, Magnin-Poull I, Proukhnitzky J, Bordet C, Palmyre A, Bloch A, Fressart V, Charron P. Molecular genetic screening after non-ischaemic sudden cardiac arrest and no overt cardiomyopathy in real life: A major tool for the aetiological diagnostic work-up. Arch Cardiovasc Dis 2024:S1875-2136(24)00051-2. [PMID: 38670870 DOI: 10.1016/j.acvd.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND With the development of advanced sequencing techniques, genetic testing has emerged as a valuable tool for the work-up of non-ischaemic sudden cardiac arrest (SCA). AIMS To evaluate the effectiveness of genetic testing in patients with unexplained SCA, according to clinical phenotype. METHODS All patients who underwent molecular genetic testing for non-ischaemic SCA with no left ventricular cardiomyopathy between 2012 and 2021 in two French university hospitals were included. RESULTS Of 66 patients (mean age 36.7±11.9years, 54.5% men), 21 (31.8%; 95% confidence interval 22.4-45.3%) carried a genetic variant: eight (12.1%) had a pathogenic or likely pathogenic (P/LP) variant and 13 (19.7%) had a variant of uncertain significance (VUS). Among 37 patients (56.1%) with no phenotypic clues, genetic testing identified a P/LP variant in five (13.5%), mainly in RYR2 (n=3) and SCN5A (n=2), and a VUS in nine (24.3%). None of the nine patients with phenotypic evidence of channelopathies had P/LP variants, but two had VUS in RYR2 and NKX2.5. Among the 20 patients with suspected arrhythmogenic cardiomyopathy, three P/LP variants (15.0%) and two VUS (10.0%) were found in DSC2, PKP2, SCN5A and DSG2, TRPM4, respectively. Genetic testing was performed sooner after cardiac arrest (P<0.001) and results were obtained more rapidly (P=0.02) after versus before 2016. CONCLUSION This study highlights the utility of molecular genetic testing with a genetic variant of interest identified in one-third of patients with unexplained SCA. Genetic testing was beneficial even in patients without phenotypic clues, with one-fourth of patients carrying a P/LP variant that could have direct implications.
Collapse
Affiliation(s)
- Orianne Weizman
- Cardiology department, Nancy university hospital, Nancy, France; AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France.
| | - Estelle Gandjbakhch
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | | | - Julie Proukhnitzky
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Céline Bordet
- AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Aurélien Palmyre
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - Adrien Bloch
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Véronique Fressart
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Philippe Charron
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France; AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France.
| |
Collapse
|
4
|
Nejad MPS, Kargin V, Hajeb-M S, Hicks D, Valentine M, Chon KH. Enhancing the accuracy of shock advisory algorithms in automated external defibrillators during ongoing cardiopulmonary resuscitation using a cascade of CNNEDs. Comput Biol Med 2024; 172:108180. [PMID: 38452474 DOI: 10.1016/j.compbiomed.2024.108180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
Delivery of continuous cardiopulmonary resuscitation (CPR) plays an important role in the out-of-hospital cardiac arrest (OHCA) survival rate. However, to prevent CPR artifacts being superimposed on ECG morphology data, currently available automated external defibrillators (AEDs) require pauses in CPR for accurate analysis heart rhythms. In this study, we propose a novel Convolutional Neural Network-based Encoder-Decoder (CNNED) structure with a shock advisory algorithm to improve the accuracy and reliability of shock versus non-shock decision-making without CPR pause in OHCA scenarios. Our approach employs a cascade of CNNEDs in conjunction with an AED shock advisory algorithm to process the ECG data for shock decisions. Initially, a CNNED trained on an equal number of shockable and non-shockable rhythms is used to filter the CPR-contaminated data. The resulting filtered signal is then fed into a second CNNED, which is trained on imbalanced data more tilted toward the specific rhythm being analyzed. A reliable shock versus non-shock decision is made when both classifiers from the cascade structure agree, while segments with conflicting classifications are labeled as indeterminate, indicating the need for additional segments to analyze. To evaluate our approach, we generated CPR-contaminated ECG data by combining clean ECG data with 52 CPR samples. We used clean ECG data from the CUDB, AFDB, SDDB, and VFDB databases, to which 52 CPR artifact cases were added, while a separate test set provided by the AED manufacturer Defibtech LLC was used for performance evaluation. The test set comprised 20,384 non-shockable CPR-contaminated segments from 392 subjects, as well as 3744 shockable CPR-contaminated samples from 41 subjects with coarse ventricular fibrillation (VF) and 31 subjects with rapid ventricular tachycardia (rapid VT). We observed improvements in rhythm analysis using our proposed cascading CNNED structure when compared to using a single CNNED structure. Specifically, the specificity of the proposed cascade of CNNED structure increased from 99.14% to 99.35% for normal sinus rhythm and from 96.45% to 97.22% for other non-shockable rhythms. Moreover, the sensitivity for shockable rhythm detection increased from 90.90% to 95.41% for ventricular fibrillation and from 82.26% to 87.66% for rapid ventricular tachycardia. These results meet the performance thresholds set by the American Heart Association and demonstrate the reliable and accurate analysis of heart rhythms during CPR using only ECG data without the need for CPR interruptions or a reference signal.
Collapse
Affiliation(s)
| | | | - Shirin Hajeb-M
- Biomedical engineering department, University of Connecticut, Storrs, CT, 06269, USA; Philips Healthcare, Bothell, WA, 98021, USA.
| | | | | | - K H Chon
- Biomedical engineering department, University of Connecticut, Storrs, CT, 06269, USA.
| |
Collapse
|
5
|
Verheul LM, Hoeksema WF, Groeneveld SA, Mulder BA, Bootsma M, Alings M, Evertz R, Blank AC, Kammeraad JAE, Clur SAB, Yap SC, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry. Heart Rhythm 2024:S1547-5271(24)00276-5. [PMID: 38493994 DOI: 10.1016/j.hrthm.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. OBJECTIVE The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. METHODS The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. RESULTS In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2-12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16-18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. CONCLUSION IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.
Collapse
Affiliation(s)
- Lisa M Verheul
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | | | - Bart A Mulder
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Reinder Evertz
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janneke A E Kammeraad
- Erasmus MC-Sophia Children's Hospital, Cardiovascular Institute, Department of Pediatric Cardiology, Rotterdam, The Netherlands
| | - Sally-Ann B Clur
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Sing-Chien Yap
- Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Paul G A Volders
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"; Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Utrecht, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| |
Collapse
|
6
|
Elizondo G, Saini A, Gonzalez de Alba C, Gregor A, Harding CO, Gillingham MB, Vinocur JM. Cardiac phenotype in adolescents and young adults with long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. Genet Med 2024; 26:101123. [PMID: 38501492 DOI: 10.1016/j.gim.2024.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency (LCHADD) is a rare fatty acid oxidation disorder characterized by recurrent episodes of metabolic decompensation and rhabdomyolysis, as well as retinopathy, peripheral neuropathy, and cardiac involvement, such as infantile dilated cardiomyopathy. Because LCHADD patients are surviving longer, we sought to characterize LCHADD-associated major cardiac involvement in adolescence and young adulthood. METHODS A retrospective cohort of 16 adolescent and young adult participants with LCHADD was reviewed for cardiac phenotype. RESULTS Major cardiac involvement occurred in 9 of 16 participants, including sudden death, out-of-hospital cardiac arrest, acute cardiac decompensations with heart failure and/or in-hospital cardiac arrest, end-stage dilated cardiomyopathy, and moderate restrictive cardiomyopathy. Sudden cardiac arrest was more common in males and those with a history of infant cardiomyopathy. CONCLUSION The cardiac manifestations of LCHADD in adolescence and early adulthood are complex and distinct from the phenotype seen in infancy. Life-threatening arrhythmia occurs at substantial rates in LCHADD, often in the absence of metabolic decompensation or rhabdomyolysis. The potential risk factors identified here-male sex and history of infant cardiomyopathy-may hint at strategies for risk stratification and possibly the prevention of these events.
Collapse
Affiliation(s)
- Gabriela Elizondo
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Ajesh Saini
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR; Portland State University, Urban Honors College, Portland, OR
| | | | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Cary O Harding
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR.
| | - Jeffrey M Vinocur
- Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
7
|
Qayoumi P, Coronel R, Folke F, Arulmurugananthavadivel A, Parveen S, Yonis H, Meaidi A, Lamberts M, Schou M, Torp-Pedersen C, Hilmar Gislason G, Eroglu TE. Sleep apnea, the risk of out-of-hospital cardiac arrest, and potential benefits of continuous positive airway pressure therapy: A nationwide study. Resuscitation 2024:110174. [PMID: 38479652 DOI: 10.1016/j.resuscitation.2024.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Patients with sleep apnea (SA) are at increased cardiovascular risk. However, little is known about the risk of out-of-hospital cardiac arrest (OHCA) in patients with SA. Therefore, we studied the relation between SA patients who did and did not receive continuous positive airway pressure (CPAP) therapy with OHCA in the general population. METHODS Using nationwide databases, we conducted a nested case-control study with OHCA-cases of presumed cardiac causes and age/sex/OHCA-date matched non-OHCA-controls from the general population. Conditional logistic regression models with adjustments for well-known OHCA risk factors were performed to generate odds ratio (OR) of OHCA comparing patients with SA receiving and not receiving CPAP therapy with individuals without SA. RESULTS We identified 46,578 OHCA-cases and 232,890 matched non-OHCA-controls [mean: 71 years, 68.8% men]. Compared to subjects without SA, having SA without CPAP therapy was associated with increased odds of OHCA after controlling for relevant confounders (OR:1.20, 95%-Cl:1.06-1.36), while having SA with CPAP therapy was not associated with OHCA (OR:1.04, 95%-Cl:0.93-1.36). Regardless of CPAP therapy, age and sex did not significantly influence our findings. Our findings were confirmed in: (I) patients with neither ischemic heart disease nor heart failure (untreated SA, OR:1.24, 95%-CI:1.04-1.47; SA with CPAP, OR:1.08, 95%-CI:0.93-1.25); and (II) in patients without cardiovascular disease (untreated SA, OR:1.33, 95%-CI:1.07-1.65; SA with CPAP, OR:1.14, 95%-CI:0.94-1.39). CONCLUSION SA not treated with CPAP was associated with OHCA, while no increased risk of OHCA was found for SA patients treated with CPAP.
Collapse
Affiliation(s)
- Pelpika Qayoumi
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Ruben Coronel
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital -Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | | | - Saaima Parveen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Harman Yonis
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Amani Meaidi
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
| |
Collapse
|
8
|
Hsu GCY, Wu MH, Chiu SN, Lin MT, Lai LP, Liu SF, Yeh SFS, Lin TT, Chiang FT, Chuang JY, Juang JMJ, Horie M. Application and validation of phenotype-enhanced variant classification in East Asian patients with catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2024; 21:349-351. [PMID: 38061421 DOI: 10.1016/j.hrthm.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Grace Chia-Yen Hsu
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ping Lai
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Fu Liu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shih-Fan Sherri Yeh
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ting-Tse Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Jing-Yuan Chuang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Heart Failure Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| |
Collapse
|
9
|
Wagner MK, Christensen J, Christensen KA, Dichman C, Gottlieb R, Kolster I, Hansen CM, Hoff H, Hassager C, Folke F, Winkel BG. A multidisciplinary guideline-based approach to improving the sudden cardiac arrest care pathway: The Copenhagen framework. Resusc Plus 2024; 17:100546. [PMID: 38260118 PMCID: PMC10801323 DOI: 10.1016/j.resplu.2023.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Although recommended in the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) Guidelines, a framework for delivering post-cardiac arrest care in a systematic manner in dedicated high-volume cardiac arrest centers is lacking in the existing literature. To our knowledge, the Copenhagen Framework is the only established framework of its kind. The framework comprises management of out-of-hospital cardiac arrest (OHCA) survivors, and follow-up, and rehabilitation. The framework also incorporates research projects on cardiac arrest survivors and their close family members. The overall aim of this paper is to describe a framework made in order to bridge the gaps between international recommendations and delivering high-quality post-resuscitation clinical care, improving the continuity of care for OHCA survivors, access to post-CA rehabilitation, a seamless transition to everyday life, and ultimately patient outcomes in the future.
Collapse
Affiliation(s)
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kate Allen Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Camilla Dichman
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Rikke Gottlieb
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ida Kolster
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Ballerup, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Helle Hoff
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Ballerup, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| |
Collapse
|
10
|
Kim YG, Kim DY, Roh SY, Jeong JH, Lee HS, Min K, Choi YY, Han KD, Shim J, Choi JI, Kim YH. Alcohol and the risk of all-cause death, atrial fibrillation, ventricular arrhythmia, and sudden cardiac arrest. Sci Rep 2024; 14:5053. [PMID: 38424149 PMCID: PMC10904378 DOI: 10.1038/s41598-024-55434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
The risk of having atrial fibrillation (AF) is associated with alcohol intake. However, it is not clear whether sudden cardiac arrest (SCA) and ventricular arrhythmia (VA) including ventricular tachycardia, flutter, or fibrillation have similar associations with alcohol. We aimed to evaluate the association of alcohol intake with all-cause death, new-onset AF, VA, and SCA using single cohort with a sufficient sample size. A total of 3,990,373 people without a prior history of AF, VAs, or SCA was enrolled in this study based on nationwide health check-up in 2009. We classified the participants into four groups according to weekly alcohol consumption, and evaluated the association of alcohol consumption with each outcome. We observed a significant association between mild (hazard ratio [HR] = 0.826; 95% confidence interval [CI] = 0.815-0.838) to moderate (HR = 0.930; 95% CI = 0.912-0.947) drinking with decreased risk of all-cause mortality. However heavy drinking (HR = 1.108; 95% CI = 1.087-1.129) was associated with increased all-cause death. The risk of new-onset AF was significantly associated with moderate (HR = 1.129; 95% CI = 1.097-1.161) and heavy (HR = 1.298; 95% CI = 1.261-1.337) drinking. However, the risk of SCA showed negative association with all degrees of alcohol intake: 20% (HR = 0.803; 95% CI = 0.769-0.839), 15% (HR = 0.853; 95% CI = 0.806-0.902), and 8% (HR = 0.918; 95% CI = 0.866-0.974) lower risk for mild, moderate, and heavy drinkers, respectively. Mild drinking was associated with reduced risk of VA with moderate and heavy drinking having no associations. In conclusion, the association between alcohol and various outcomes in this study were heterogeneous. Alcohol might have different influences on various cardiac disorders.
Collapse
Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Dong Yun Kim
- Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Guro Hospital, Seoul, Republic of Korea
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| |
Collapse
|
11
|
Christensen J, Winkel BG, Kirkeskov L, Folke F, Winther-Jensen M, Eckhardt-Bentsen C, Kjærgaard J, Hassager C, Wagner MK. The ROCK trial-a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol. Trials 2024; 25:99. [PMID: 38303019 PMCID: PMC10835971 DOI: 10.1186/s13063-024-07911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Most cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care. METHODS AND ANALYSIS The ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA. DISCUSSION The ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov NCT05173740. Registered on May 2018.
Collapse
Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital-Rigshospitalet, 2100, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lilli Kirkeskov
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christine Eckhardt-Bentsen
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
12
|
Jeong JH, Kim YG, Han KD, Roh SY, Lee HS, Choi YY, Shim J, Choi JI, Kim YH. Association of temporal change in body mass index with sudden cardiac arrest in diabetes mellitus. Cardiovasc Diabetol 2024; 23:46. [PMID: 38281993 PMCID: PMC10823669 DOI: 10.1186/s12933-024-02130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Underweight imposes significant burden on cardiovascular outcomes in patients with diabetes mellitus. However, less is known about the impact of serial change in body weight status measured as body mass index (BMI) on the risk of sudden cardiac arrest (SCA). This study investigated the association between SCA and temporal change in BMI among patients with diabetes mellitus. METHODS Based on Korean National Health Insurance Service database, participants with diabetes mellitus who underwent health examination between 2009 and 2012 and had prior health examination data (four years ago, 2005-2008) were retrospectively analyzed. BMI was measured at baseline (2005-2008) and 4-year follow-up health examination (2009-2012). Patients were classified in four groups according to the body weight status and its temporal change: sustained non-underweight, sustained underweight, previous underweight, and newly developed underweight. Primary outcome was defined as occurrence of SCA. RESULTS A total of 1,355,746 patients with diabetes mellitus were included for analysis, and SCA occurred in 12,554 cases. SCA was most common in newly developed underweight (incidence rate = 4.45 per 1,000 person-years), followed by sustained underweight (incidence rate = 3.90), previous underweight (incidence rate = 3.03), and sustained non-underweight (incidence rate = 1.34). Adjustment of covariates resulted highest risk of SCA in sustained underweight (adjusted hazard ratio = 2.60, 95% confidence interval [2.25-3.00], sustained non-underweight as a reference), followed by newly developed underweight (2.42, [2.15-2.74]), and previous underweight (2.12, [1.77-2.53]). CONCLUSIONS In diabetes mellitus, sustained underweight as well as decrease in body weight during 4-year follow-up imposes substantial risk on SCA. Recovery from underweight over time had relatively lower, but yet increased risk of SCA. Both underweight and dynamic decrease in BMI can be associated with increased risk of SCA.
Collapse
Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| |
Collapse
|
13
|
Bakker AM, Albrecht M, Verkaik BJ, de Jonge RCJ, Buysse CMP, Blom NA, Rammeloo LAJ, Verhagen JMA, Riedijk MA, Yap SC, Tan HL, Kammeraad JAE. Sudden cardiac arrest in infants and children: proposal for a diagnostic workup to identify the etiology. An 18-year multicenter evaluation in the Netherlands. Eur J Pediatr 2024; 183:335-344. [PMID: 37889292 PMCID: PMC10858117 DOI: 10.1007/s00431-023-05301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
Sudden cardiac arrest (SCA) studies are often population-based, limited to sudden cardiac death, and excluding infants. To guide prevention opportunities, it is essential to be informed of pediatric SCA etiologies. Unfortunately, etiologies frequently remain unresolved. The objectives of this study were to determine paediatric SCA etiology, and to evaluate the extent of post-SCA investigations and to assess the performance of previous cardiac evaluation in detecting conditions predisposing to SCA. In a retrospective cohort (2002-2019), all children 0-18 years with out-of-hospital cardiac arrest (OHCA) referred to Erasmus MC Sophia Children's Hospital or the Amsterdam UMC (tertiary-care university hospitals), with cardiac or unresolved etiologies were eligible for inclusion. SCA etiologies, cardiac and family history and etiologic investigations in unresolved cases were assessed. The etiology of arrest could be determined in 52% of 172 cases. Predominant etiologies in children ≥ 1 year (n = 99) were primary arrhythmogenic disorders (34%), cardiomyopathies (22%) and unresolved (32%). Events in children < 1 year (n = 73) were largely unresolved (70%) or caused by cardiomyopathy (8%), congenital heart anomaly (8%) or myocarditis (7%). Of 83 children with unresolved etiology a family history was performed in 51%, an autopsy in 51% and genetic testing in 15%. Pre-existing cardiac conditions presumably causative for SCA were diagnosed in 9%, and remained unrecognized despite prior evaluation in 13%. CONCLUSION SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield. WHAT IS KNOWN • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children. WHAT IS NEW • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
Collapse
Affiliation(s)
- Ashley M Bakker
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands
| | - Marijn Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bas J Verkaik
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nico A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maaike A Riedijk
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sing C Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hanno L Tan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands.
| |
Collapse
|
14
|
Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| |
Collapse
|
15
|
Eroglu TE, Halili A, Arulmurugananthavadivel A, Coronel R, Kessing LV, Fosbøl EL, Folke F, Torp-Pedersen C, Gislason GH. Use of methylphenidate is associated with increased risk of out-of-hospital cardiac arrest in the general population: a nationwide nested case-control study. Eur Heart J Cardiovasc Pharmacother 2023; 9:658-665. [PMID: 37070942 DOI: 10.1093/ehjcvp/pvad028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/22/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
AIM Methylphenidate, a sympathomimetic drug prescribed to treat attention-deficit/hyperactivity disorder (ADHD), is associated with cardiovascular events, but few studies have explored the risk of out-of-hospital cardiac arrest (OHCA). We investigated whether methylphenidate use is associated with OHCA in the general population. METHODS AND RESULTS Using Danish nationwide registries, we conducted a nested case-control study with OHCA cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA controls from the general population. Conditional logistic regression models with adjustments for well-known risk factors of OHCA were employed to estimate the odds ratio (OR) of OHCA by comparing methylphenidate use with no use of methylphenidate.The study population consisted of 46 578 OHCA cases [median: 72 years (interquartile range: 62-81), 68.8% men] and 232 890 matched controls. Methylphenidate was used by 80 cases and 166 controls, and was associated with an increased OR of OHCA compared with non-users {OR: 1.78 [95% confidence interval (CI): 1.32-2.40]}. The OR was highest in recent starters (OR≤180 days: 2.59, 95% CI: 1.28-5.23). The OR of OHCA associated with methylphenidate use did not vary significantly by age (P-value interaction: 0.37), sex (P-value interaction: 0.94), and pre-existing cardiovascular disease (P-value interaction: 0.27). Furthermore, the ORs remained elevated when we repeated the analyses in individuals without registered hospital-based ADHD (OR: 1.85, 95% CI: 1.34-2.55), without severe psychiatric disorders (OR: 1.98, 95% CI: 1.46-2.67), without depression (OR: 1.93, 95% CI: 1.40-2.65), or in non-users of QT-prolonging drugs (OR: 1.79, 95% CI: 1.27-2.54). CONCLUSION Methylphenidate use is associated with an increased risk of OHCA in the general population. This increased risk applies to both sexes and is independent of age and the presence of cardiovascular disease.
Collapse
Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Andrim Halili
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anojhaan Arulmurugananthavadivel
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam UMC, Academic Medical Center, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| |
Collapse
|
16
|
Verheul LM, van der Ree MH, Groeneveld SA, Mulder BA, Christiaans I, Kapel GFL, Alings M, Bootsma M, Barge-Schaapveld DQCM, Balt JC, Yap SC, Krapels IPC, Ter Bekke RMA, Volders PGA, van der Crabben SN, Postema PG, Wilde AAM, Dooijes D, Baas AF, Hassink RJ. The genetic basis of apparently idiopathic ventricular fibrillation: a retrospective overview. Europace 2023; 25:euad336. [PMID: 37967257 PMCID: PMC10665040 DOI: 10.1093/europace/euad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIMS During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. The aim of this study was to evaluate genetic testing and its results in idiopathic VF patients. METHODS AND RESULTS We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry. Genetic testing was performed in 379 (91%) patients [median age at event 39 years (27-51), 60% male]. Single-gene testing was performed in 87 patients (23%) and was initiated more often in patients with idiopathic VF before 2010. Panel testing was performed in 292 patients (77%). The majority of causal (likely) pathogenic variants (LP/P, n = 56, 15%) entailed the DPP6 risk haplotype (n = 39, 70%). Moreover, 10 LP/P variants were found in cardiomyopathy genes (FLNC, MYL2, MYH7, PLN (two), TTN (four), RBM20), and 7 LP/P variants were identified in genes associated with cardiac arrhythmias (KCNQ1, SCN5A (2), RYR2 (four)). For eight patients (2%), identification of an LP/P variant resulted in a change of diagnosis. In 113 patients (30%), a VUS was identified. Broad panel testing resulted in a higher incidence of VUS in comparison to single-gene testing (38% vs. 3%, P < 0.001). CONCLUSION Almost all patients from the registry underwent, albeit not broad, genetic testing. The genetic yield of causal LP/P variants in idiopathic VF patients is 5%, increasing to 15% when including DPP6. In specific cases, the LP/P variant is the underlying diagnosis. A gene panel specifically for idiopathic VF patients is proposed.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Martijn H van der Ree
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Imke Christiaans
- Department of Human Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs F L Kapel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ingrid P C Krapels
- Department of Human Genetics, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Saskia N van der Crabben
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Dennis Dooijes
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annette F Baas
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| |
Collapse
|
17
|
Usman M, Qureshi HZ, Zahid K, Bukhari SN. Role of coronary arteries in patients with Acute Coronary Syndrome. Pak J Med Sci 2023; 39:1717-1719. [PMID: 37936760 PMCID: PMC10626102 DOI: 10.12669/pjms.39.6.7173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To assess the role of coronary arteries in acute coronary syndrome patients who have survived sudden cardiac arrest. Method A cross-sectional study was conducted in Department of Cardiology at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan from 1st May 2021 to 1st October 2021. A total of 203 patients who were diagnosed with sudden cardiac arrest were included as subjects of the study. Baseline data of all patients including age, sex, body mass index, history of smoking, diabetes and hypertension was noted. Coronary angiography was performed in all patients within five days after admission in hospital due to SCA. Results The average age of patients was 52.61±11.09 years. There were 140 (68.97%) male and 63 (31.03%) female patients. There were 131 (64.53%) patients with STEMI and 72 (35.47%) patients with Non-STEMI. LMCAD were diagnosed in 29 (14.29%) patients, RCA in 88 (43.35%) patients, LAD in 174 (85.71%) Patients and LCX in 41 (20.20%) patients. Conclusion LAD has the most involvement among the coronary arteries (85.71%) in patients with sudden cardiac arrest.
Collapse
Affiliation(s)
- Muhammad Usman
- Dr. Muhammad Usman, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Hareem Zahra Qureshi
- Dr. Hareem Zahra Qureshi, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Kiran Zahid
- Dr. Kiran Zahid, MBBS, FCPSI, WMO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Syed Naseem Bukhari
- Dr. Syed Naseem Bukhari, MBBS, FCPS, Assistant Professor, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| |
Collapse
|
18
|
Aqel S, Syaj S, Al-Bzour A, Abuzanouneh F, Al-Bzour N, Ahmad J. Artificial Intelligence and Machine Learning Applications in Sudden Cardiac Arrest Prediction and Management: A Comprehensive Review. Curr Cardiol Rep 2023; 25:1391-1396. [PMID: 37792134 PMCID: PMC10682172 DOI: 10.1007/s11886-023-01964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW This literature review aims to provide a comprehensive overview of the recent advances in prediction models and the deployment of AI and ML in the prediction of cardiopulmonary resuscitation (CPR) success. The objectives are to understand the role of AI and ML in healthcare, specifically in medical diagnosis, statistics, and precision medicine, and to explore their applications in predicting and managing sudden cardiac arrest outcomes, especially in the context of prehospital emergency care. RECENT FINDINGS The role of AI and ML in healthcare is expanding, with applications evident in medical diagnosis, statistics, and precision medicine. Deep learning is gaining prominence in radiomics and population health for disease risk prediction. There's a significant focus on the integration of AI and ML in prehospital emergency care, particularly in using ML algorithms for predicting outcomes in COVID-19 patients and enhancing the recognition of out-of-hospital cardiac arrest (OHCA). Furthermore, the combination of AI with automated external defibrillators (AEDs) shows potential in better detecting shockable rhythms during cardiac arrest incidents. AI and ML hold immense promise in revolutionizing the prediction and management of sudden cardiac arrest, hinting at improved survival rates and more efficient healthcare interventions in the future. Sudden cardiac arrest (SCA) continues to be a major global cause of death, with survival rates remaining low despite advanced first responder systems. The ongoing challenge is the prediction and prevention of SCA. However, with the rise in the adoption of AI and ML tools in clinical electrophysiology in recent times, there is optimism about addressing these challenges more effectively.
Collapse
Affiliation(s)
- Sarah Aqel
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayah Al-Bzour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Faris Abuzanouneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Noor Al-Bzour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jamil Ahmad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
19
|
Bergeman AT, Robyns T, Amin AS, Wilde AAM, van der Werf C. Importance of exercise stress testing in evaluation of unexplained cardiac arrest survivor. Neth Heart J 2023; 31:444-451. [PMID: 37347419 PMCID: PMC10602994 DOI: 10.1007/s12471-023-01789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In sudden cardiac arrest survivors without an immediately identifiable cause, additional extensive yet individualised testing is required. METHODS We describe 3 survivors of sudden cardiac arrest in whom exercise stress testing was not performed during the initial hospital admission. RESULTS All 3 patients were incorrectly diagnosed with long QT syndrome based on temporary sudden cardiac arrest-related heart rate-corrected QT interval prolongation, and exercise stress testing was not performed during the initial work-up. When they were subjected to exercise stress testing during follow-up, a delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT) was made. As a result, these patients were initially managed inappropriately, and their family members were initially not screened for CPVT. CONCLUSION In sudden cardiac arrest survivors without an immediately identifiable cause, omission of exercise stress testing or erroneous interpretation of the results can lead to a delayed or missed diagnosis of CPVT, which may have considerable implications for survivors and their family.
Collapse
Affiliation(s)
- Auke T Bergeman
- Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ahmad S Amin
- Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Christian van der Werf
- Heart Centre, Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium.
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.
| |
Collapse
|
20
|
Chiu YW, Su MH, Lin YF, Chen CY, Chen TT, Wang SH. Causal influence of sleeping phenotypes on the risk of coronary artery disease and sudden cardiac arrest: A Mendelian randomization analysis. Sleep Health 2023; 9:726-732. [PMID: 37429813 DOI: 10.1016/j.sleh.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To assess the causal influence of sleep and circadian traits on coronary artery disease and sudden cardiac arrest with adjustment for obesity through a two-sample Mendelian randomization study. METHODS We used summary statistics of 5 sleep and circadian traits for genome-wide association studies, including chronotype, sleep duration, long sleep (≥9 h a day), short sleep (<7 h a day), and insomnia (sample size range: 237,622-651,295). Coronary artery disease genome-wide association studies with 60,801 cases and 123,504 controls, sudden cardiac arrest genome-wide association studies with 3939 cases and 25,989 controls, and obesity genome-wide association studies with 806,834 individuals were also used. Multivariable Mendelian randomization was performed to estimate the causality. RESULTS After adjusting for obesity, genetically predicted short sleep (odds ratio = 1.87 and p = .02), and genetically predicted insomnia (odds ratio = 1.17 and p = .001) were causally associated with increased odds of coronary artery disease. Genetically predicted long sleep (odds ratio = 0.06 and p = .02) and genetically predicted longer sleep duration (odds ratio = 0.36 for per-hour increase in sleep duration and p = .0006) were causally associated with decreased odds of sudden cardiac arrest. CONCLUSIONS The findings of this Mendelian randomization study indicate that insomnia and short sleep contribute to the development of coronary artery disease, whereas a longer sleep duration protects from sudden cardiac arrest, independent of the influence of obesity. The mechanisms underlying these associations warrant further investigation.
Collapse
Affiliation(s)
- Yen-Wei Chiu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Mei-Hsin Su
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Yen-Feng Lin
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Yen Chen
- Biogen, Cambridge, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tzu-Ting Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shi-Heng Wang
- College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan.
| |
Collapse
|
21
|
Patel H, Mahtani AU, Mehta LS, Kalra A, Prabhakaran D, Yadav R, Naik N, Tamirisa KP. Outcomes of out of hospital sudden cardiac arrest in India: A review and proposed reforms. Indian Heart J 2023; 75:321-326. [PMID: 37657626 PMCID: PMC10568059 DOI: 10.1016/j.ihj.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) is the cornerstone in managing out-of-hospital cardiac arrest (OHCA). However, India lacks a formal sudden cardiac arrest (SCA) registry and the infrastructure for a robust emergency medical services (EMS) response system. Also, there exists an opportunity to improve widespread health literacy and awareness regarding SCA. Other confounding variables, including religious, societal, and cultural sentiments hindering timely intervention, need to be considered for better SCA outcomes. OBJECTIVES We highlight the current trends and practices of managing OHCA in India and lay the groundwork for improving the awareness, education, and infrastructure regarding the management of SCA. CONCLUSION Effective management of OHCA in India needs collaborative grassroots reformation. Establishing a large-scale SCA registry and creating official and societal guidelines will be pivotal for transforming OHCA patient outcomes.
Collapse
Affiliation(s)
- Hiren Patel
- Department of Cardiology, Saint Louis University School of Medicine, St. Louis, MO, United States; Department of Cardiology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, United States
| | - Laxmi S Mehta
- Department of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN, United States
| | | | - Rakesh Yadav
- Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Kamala P Tamirisa
- Clinical Cardiac Electrophysiologist, Texas Cardiac Arrhythmia Institute, Austin and Dallas, Texas, United States.
| |
Collapse
|
22
|
Bak MA, Vroonland JC, Blom MT, Damjanovic D, Willems DL, Tan HL, Corrette Ploem M. Data-driven sudden cardiac arrest research in Europe: Experts' perspectives on ethical challenges and governance strategies. Resusc Plus 2023; 15:100414. [PMID: 37363125 PMCID: PMC10285638 DOI: 10.1016/j.resplu.2023.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Observational studies using large-scale databases and biobanks help improve prevention and treatment of sudden cardiac arrest (SCA) but the lack of guidance on data protection issues in this setting may harm patients' rights and the research enterprise itself. This qualitative study explored the ethical aspects of observational SCA research, as well as solutions. Methods European experts in SCA research, medical ethics and health law reflected on this topic through semi-structured interviews (N = 29) and a virtual roundtable conference (N = 18). The ESCAPE-NET project served as a discussion case. Findings were coded and thematically analysed. Results The first theme concerned the potential benefits and harms (at individual and group level) of observational data-based SCA studies and included the following sub-themes: societal value, scientific validity, data privacy, disclosure of genetic findings, stigma and discrimination, and medicalisation of sudden death. The second theme involved governance through 'privacy by design', 'privacy by policy' and associated regulation and oversight. Sub-themes were: de-identification of data, informed consent (broad and deferred), ethics review, and harmonisation. Conclusions Researchers and scientific societies should be aware that ethico-legal issues may arise during data-driven studies in SCA and other emergencies. These can be mitigated by combining technical data protection safeguards with appropriate informed consent policies and proportional ethics oversight. To ensure responsible conduct of data research in emergency medicine, we recommend the establishment of 'codes of conduct' which should be developed in interdisciplinary groups and together with patient representatives.
Collapse
Affiliation(s)
- Marieke A.R. Bak
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | - Marieke T. Blom
- Department of Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Chronic Disease & Health Behaviour, Amsterdam, The Netherlands
| | - Domagoj Damjanovic
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dick L. Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Hanno L. Tan
- Department of Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - M. Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| |
Collapse
|
23
|
Leslie F, Avis SR, Bagnall RD, Bendall J, Briffa T, Brouwer I, Butters A, Figtree GA, La Gerche A, Gray B, Nedkoff L, Page G, Paratz E, Semsarian C, Sy RW, du Toit-Prinsloo L, Yeates L, Sweeting J, Ingles J. The New South Wales Sudden Cardiac Arrest Registry: A Data Linkage Cohort Study. Heart Lung Circ 2023; 32:1069-1075. [PMID: 37419791 DOI: 10.1016/j.hlc.2023.06.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/04/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Sudden cardiac arrest (SCA) in young people aged 1 to 50 years often occurs with no presenting symptoms or risk factors prompting screening for cardiovascular disease prior to their cardiac arrest. Approximately 3,000 young Australians suffer from sudden cardiac death (SCD) each year, making this a major public health issue. However, there is significant variation in the way incidence is estimated resulting in discrepancy across reporting which impacts our ability to understand and prevent these devastating events. We describe the New South Wales (NSW) Sudden Cardiac Arrest Registry: a retrospective, data linkage study which will identify all SCAs in the young in NSW from 2009 through to June 2022. OBJECTIVE To determine the incidence, demographic characteristics and causes of SCA in young people. We will develop an NSW-based registry that will contribute to a greater understanding of SCA including risk factors and outcomes. METHODS The cohort will include all people who experience a SCA in the NSW community aged between 1 to 50 years. Cases will be identified using the following three datasets: the Out of Hospital Cardiac Arrest Register housed at NSW Ambulance, the NSW Emergency Department Data Collection, and the National Coronial Information System. Data from eight datasets will be collected, anonymised and linked for the entire cohort. Analysis will be undertaken and reported using descriptive statistics. CONCLUSIONS The NSW SCA registry will be an important resource for the improved understanding of SCA and inform the widespread impacts it has on individuals, their families and society.
Collapse
Affiliation(s)
- Felicity Leslie
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Suzanne R Avis
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Tasmanian School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Richard D Bagnall
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jason Bendall
- Clinical Systems, NSW Ambulance, Sydney, NSW, Australia; Department of Rural Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Isabel Brouwer
- Forensic Medicine, Forensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia
| | - Alexandra Butters
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Belinda Gray
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Christopher Semsarian
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lorraine du Toit-Prinsloo
- Forensic Medicine, Forensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia
| | - Laura Yeates
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joanna Sweeting
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| |
Collapse
|
24
|
Kovoor JG, Bacchi S, Gupta AK, Stretton B, Page GJ, Kovoor P. Refining Automated External Defibrillator Signage to Improve Out-of-Hospital Cardiac Arrest Survival. Heart Lung Circ 2023; 32:e51-e52. [PMID: 37673552 DOI: 10.1016/j.hlc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/josh.kovoor
| | - Stephen Bacchi
- Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia; Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gregory J Page
- Heart of the Nation, Sydney, NSW, Australia. http://www.twitter.com/GregPage_Yellow
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; University of Sydney, Westmead Hospital, Sydney, NSW, Australia.
| |
Collapse
|
25
|
Gil KE, Truong VT, Zareba KM, Varghese J, Simonetti OP, Rajpal S. Parametric mapping by cardiovascular magnetic resonance imaging in sudden cardiac arrest survivors. Int J Cardiovasc Imaging 2023; 39:1547-1555. [PMID: 37147450 DOI: 10.1007/s10554-023-02864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
Etiology of sudden cardiac arrest (SCA) is identified in less than 30% of survivors without coronary artery disease. We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology. Consecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for establishing probable SCA etiology by CMR if the SCA cause could not have been determined without its utilization. If the CMR diagnosis could have been potentially based on the combination of cine and LGE imaging, parametric mapping was considered contributory. Of the 35 patients (mean age 46.9 ± 14.1 years; 57% males) included, SCA diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases. Inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis.
Collapse
Affiliation(s)
- Katarzyna E Gil
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA.
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
| | - Vien T Truong
- Department of Internal Medicine, Nazareth Hospital, Pennsylvania, PA, USA
| | - Karolina M Zareba
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Juliet Varghese
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rajpal
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 452 W 10th Ave, Columbus, OH, 43210, USA
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
26
|
Kazawa S, Satomi K, Murakami H, Tanaka N. Case report: successful termination of ventricular tachycardia by intrinsic anti-tachycardia pacing beyond conventional anti-tachycardia pacing. Eur Heart J Case Rep 2023; 7:ytad285. [PMID: 37425658 PMCID: PMC10328381 DOI: 10.1093/ehjcr/ytad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Background Anti-tachycardia pacing (ATP) is a pain-free alternative to defibrillation shock for monomorphic ventricular tachycardia (VT). Intrinsic ATP (iATP) is a novel algorithm of auto-programmed ATP. However, the advantage of iATP over conventional ATP in clinical cases is still unknown. Case summary A 49-year-old man with no significant past medical history was transferred to our institution with sudden-onset fatigue from working on a farm. A 12-lead electrocardiogram showed monomorphic sustained wide QRS tachycardia with a right bundle branch block pattern and superior axis deviation with a cycle length (CL) of 300 ms. Sustained monomorphic VT originating from the left ventricle due to underlying vasospastic angina was diagnosed by contrast-enhanced cardiac magnetic resonance imaging, coronary angiography, and the acetylcholine stress test, and implantable cardioverter defibrillator implantation was performed. Nine months later, a clinical VT episode with a CL of 300 ms was observed, which could not be terminated by three sequences of conventional burst pacing. Ventricular tachycardia was finally terminated by a third iATP sequence without any acceleration. Discussion Although standard burst pacing by conventional ATP reached the VT circuit, it failed to terminate the VT. Using the post-pacing interval, iATP automatically calculated the appropriate number of S1 pulses required to reach the VT circuit. In iATP, the S2 pulses are delivered with a calculated coupling interval based on the estimated effective refractory period during tachycardia. In this case, iATP might have led to less aggressive S1 stimulation, followed by aggressive S2 stimulation, which probably helped terminate the VT without any acceleration.
Collapse
Affiliation(s)
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetaka Murakami
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan
| |
Collapse
|
27
|
Verhey JT, Poon SK. General Medical Emergencies in Athletes. Clin Sports Med 2023; 42:427-440. [PMID: 37208057 DOI: 10.1016/j.csm.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.
Collapse
Affiliation(s)
- Jens T Verhey
- Orthopaedic Surgery Residency, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Steven K Poon
- Sports Medicine Section, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
| |
Collapse
|
28
|
Favorini S, Perrin T, Hellige G, Arenja N. Sudden cardiac arrest due to recurrent coronary spasm in a young woman: a case report. Eur Heart J Case Rep 2023; 7:ytad253. [PMID: 37378054 PMCID: PMC10291570 DOI: 10.1093/ehjcr/ytad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/10/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023]
Abstract
Background Coronary artery spasm (CAS) is a pathological condition resulting from transient functional narrowing of the coronary arteries leading to myocardial ischaemia and in some rare cases even to sudden cardiac arrest (SCA). The most important preventable risk factor is use of tobacco, whereas possible precipitating factors include some medications and psychological stress. Case summary A 32-year-old woman was hospitalized with burning chest pain. The immediate investigations revealed the diagnosis of non-ST-segment elevation myocardial infarction, because of ST elevations in one single lead and increased high-sensitivity troponin. Due to ongoing chest pain and a severe impaired left ventricular ejection fraction (LVEF) of 30% with apical akinesia, a prompt coronary angiography (CAG) was scheduled. After aspirin administration, she developed anaphylaxis with pulseless electrical activity (PEA). She could be resuscitated successfully. CAG revealed multi-vessel CAS for which she received calcium channel blockers. Five days after, she suffered from a second SCA due to ventricular fibrillation and was resuscitated again. Repeated CAG showed no critical coronary artery occlusion. LVEF improved progressively during hospitalization. Drug therapy was increased, and a subcutaneous implantable cardioverter defibrillator (ICD) was implanted for secondary prevention. Discussion CAS may in some instances lead to SCA, especially in case of multi-vessel involvement. Allergic and anaphylactic events can trigger CAS, which are frequently underestimated. Regardless of the cause, cornerstone of CAS prophylaxes remains optimal medical therapy as in the avoidance of predisposing risk factors. In case of life-threatening arrhythmia, the implantation of an ICD should be considered.
Collapse
Affiliation(s)
- Serena Favorini
- Department of Cardiology, Spital Uster, Brunnenstrasse 42, 8610 Uster, Switzerland
| | - Tilman Perrin
- Department of Cardiology, Kantonsspital Olten and Bürgerspital Solothurn, Schöngrünstrasse 36A, 4500 Solothurn, Switzerland
| | - Gerrit Hellige
- Department of Cardiology, Kantonsspital Olten and Bürgerspital Solothurn, Schöngrünstrasse 36A, 4500 Solothurn, Switzerland
| | | |
Collapse
|
29
|
Ben Ahmed H, Bellali M, Allouche E, Allouche M, Belhadj A, Ben Khelil M, Shimi M, Razghallah R, Banasr A, Benzarti A, Bezdah L, Hamdoun M. [Circadian and septadian variation in sudden cardiac death : Autopsy registry of the Tunisian North]. Ann Cardiol Angeiol (Paris) 2023; 72:101597. [PMID: 37075563 DOI: 10.1016/j.ancard.2023.101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Several studies have suggested a circadian and septadian pattern of incidence of sudden cardiac death with a morning peak and a Monday peak. OBJECTIVE To analyze the circadian and septadian pattern of occurrence of sudden cardiac death in the eight northern Tunisian governorates. METHODS We prospectively collected epidemiological and autopsy data of sudden cardiac death victims occurring in the northern region of Tunisia between January 2013 and December 2019. RESULTS The population included 1834 men (79.6%) and 468 women (20.4%) with a mean age of 56.5 ± 14 years. Smoking (53.9%) was the most prevalent cardiovascular risk factor. One-fifth (20.9%) of victims had known heart disease, and 3% had a family history of sudden death. ischemic heart disease was the leading cause of sudden death (46.8% of cases). One- fourth (25.7%) of autopsies were negative. Analysis of the circadian pattern of occurrence of sudden cardiac death identified a peak (36.1%, p < 0.001) between midnight and 6 am. This nocturnal excess mortality was significant (p < 0.001) and independent of sex (34.1 % in men and 43.8 % in women) and cause of death (39.3 % of cases of sudden ischemic death and 33.3 % of cases of nonischemic death). Moreover, there was a significant septadian variability in the occurrence of sudden death (p: 0.0015), with a peak on Friday (15.8 %, p: 0.042). CONCLUSION This study showed a peak of sudden death between midnight and 6 am, and on Fridays, confirming the modification of the classic circadian and septadian pattern of sudden death occurrence. These results may help optimize the deployment of emergency mobile teams and structures during the most vulnerable periods.
Collapse
Affiliation(s)
- H Ben Ahmed
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Bellali
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - E Allouche
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie.
| | - M Allouche
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Belhadj
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Ben Khelil
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Shimi
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - R Razghallah
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Banasr
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - A Benzarti
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - L Bezdah
- Service de cardiologie, Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| | - M Hamdoun
- Service de Médecine Légale Hôpital Charles Nicolle, Tunis. Faculté de Médecine, Université Tunis El Manar 2092-Tunis, Tunisie
| |
Collapse
|
30
|
Goetz G, Wernly B, Wild C. Wearable cardioverter defibrillator for preventing sudden cardiac death in patients at risk: An updated systematic review of comparative effectiveness and safety. Int J Cardiol Heart Vasc 2023; 45:101189. [PMID: 37025482 PMCID: PMC10070821 DOI: 10.1016/j.ijcha.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
Objectives To synthesise the available evidence of wearable cardioverter defibrillator (WCD) therapy as an add-on measure to optimal medical therapy (OMT) or as a replacement of hospital stay. Methods An update systematic review (SR) of comparative effectiveness and safety of WCD therapy was conducted. We included randomised controlled trials (RCT), prospective comparative studies and prospective uncontrolled studies with at least 100 patients. A narrative synthesis of the evidence was conducted. Results One RCT (n = 2348) and further eleven observational studies (n = 5345) fulfilled our inclusion criteria. In the only available RCT, the use of the WCD was not statistically associated with a clinical benefit on arrhythmic mortality in post-myocardial infarction (MI) patients with an ejection fraction of ≤35%. The compliance with WCD therapy was low in the RCT and high in observational studies, with ten observational studies reporting on a daily wear time between 20 and 23.5 h. The range of percentage of patients receiving at least one appropriate shock was 1-4.8% and the rate of first shock success was reported to be 100% in three studies. Serious adverse events (SAEs) such as inappropriate shocks occurred rarely, with between 0% and 2% of patients being inappropriately shocked within ten observational studies. In one of the observational studies, two patients (2%) were allergic to nickel developing skin rash and false alarms occurred in 58 patients (57%) in this study. Another registry study (n = 448) reported milder AEs, such as dermatitis and pressure marks, occurring in 0.9% and 0.2% of enrolled patients, respectively. Conclusion The only available RCT failed to show superiority of add-on use of WCD in post MI patients. Observational evidence shows that the compliance with WCD is good, but the evidence is afflicted with selection bias and the inclusion of diverse mixed patient populations diluting the ability to draw indication-specific conclusions on the utility of the device. More comparative data is needed to justify continuing or expanding use of WCD therapy.
Collapse
Affiliation(s)
- Gregor Goetz
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
- Department of Health Care Management, Technical University Berlin, Germany
| | - Bernhard Wernly
- Institute of general practice, family medicine and preventive medicine, Strubergasse 21, 5020 Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Claudia Wild
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
| |
Collapse
|
31
|
Nalliah C, Raju H, Jagoda C, Semsarian C. FINDING A CAUSE IN SUDDEN CARDIAC ARREST SURVIVORS: GETTING THE TESTING RIGHT. J Cardiovasc Electrophysiol 2023; 34:1329-1331. [PMID: 36934399 DOI: 10.1111/jce.15887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
Sudden cardiac death (SCD) increases with age, with the incidence among persons in their fifth and sixth decades of life reaching 50 per 100,000 patient years. 1 However, SCD and sudden cardiac arrest (SCA) in the young remains one of the most poorly understood causes of death in cardiovascular medicine, comprising a broad range of pathologic entities that encompass both genetic and structural causes. 2 Understanding the fundamental substrate is critical for effective management and prevention of future adverse events. Furthermore, accurate definition of the aetiologic basis has implications for screening and early intervention among other family members. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Chrishan Nalliah
- Faculty of Health and Medical Sciences Macquarie University, Sydney, Australia.,Department of Cardiology, Macquarie University Hospital, Sydney, Australia.,Department of Cardiology, Bankstown Hospital, Sydney, Australia
| | - Hariharan Raju
- Faculty of Health and Medical Sciences Macquarie University, Sydney, Australia.,Department of Cardiology, Macquarie University Hospital, Sydney, Australia.,Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Chamath Jagoda
- Faculty of Health and Medical Sciences Macquarie University, Sydney, Australia.,Department of Cardiology, Macquarie University Hospital, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, at Centenary Institute, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
32
|
Koivunen M, Tynkkynen J, Oksala N, Eskola M, Hernesniemi J. Incidence of sudden cardiac arrest and sudden cardiac death after unstable angina pectoris and myocardial infarction. Am Heart J 2023; 257:9-19. [PMID: 36384178 DOI: 10.1016/j.ahj.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac arrests (SCA) and sudden cardiac deaths (SCD) are believed to account for a large proportion of deaths due to cardiovascular causes. The purpose of this study is to provide comprehensive information on the epidemiology of SCAs and SCDs after acute coronary syndrome. METHODS The incidence of SCA (including SCDs) was studied retrospectively among 10,316 consecutive patients undergoing invasive evaluation for acute coronary syndrome (ACS) between 2007 and 2018 at Tays Heart Hospital (sole provider of specialized cardiac care for a catchment area of over 0.5 million residents). Baseline and follow-up information was collected by combining information from the hospital's electronic health records, death certificate data, and a full-disclosure review of written patient records and accounts of the circumstances leading to death. RESULTS During 12 years of follow-up, the cumulative incidence of SCAs (including SCDs) was 9.8% (0.8% annually) and that of SCDs 5.4% (0.5% annually). Cumulative incidence of SCAs in patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris were: 11.9%,10.2% and 5.7% at 12 years. SCAs accounted for 30.5% (n = 528/1,732) of all deaths due to cardiovascular causes. The vast majority of SCAs (95.6%) occurred in patients without implantable cardioverter defibrillator (ICD) devices or among patients with no recurrent hospitalizations for coronary artery disease (89.1%). CONCLUSIONS SCAs accounted for less than a third of all deaths due to cardiovascular causes among patients with previous ACS. Incidence of SCA is highest among STEMI and NSTEMI patients. After the hospital discharge, most of SCAs happen to NSTEMI patients.
Collapse
Affiliation(s)
- Minna Koivunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
33
|
Singh B, Hsieh YC, Liu YB, Lin KH, Joung B, Rodriguez DA, Chasnoits AR, Huang D, Zhang S, O'Brien JE, Lexcen DR, Cerkvenik J, Van Dorn B, Ching CK. Cardioverter-defibrillator reduces mortality risk in eligible ischemic and non-ischemic cardiomyopathy patients: Sub-analysis of the multi-center Improve SCA study. Indian Heart J 2023; 75:115-121. [PMID: 36736459 PMCID: PMC10123448 DOI: 10.1016/j.ihj.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND & OBJECTIVE Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. METHODS Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. RESULTS Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38-0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33-.0.88, p = 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p ≥ 0.263). CONCLUSIONS In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02099721.
Collapse
Affiliation(s)
- Balbir Singh
- Department of Cardiology, Pan Max Hospital, New Delhi, India.
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University School of Medicine, Taichung, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Internal Medicine Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Hung Lin
- Department of Cardiology, China Medical Center University Hospital, Taichung, Taiwan
| | - Boyoung Joung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Diego A Rodriguez
- Instituto de Cardiología, Fundación Cardio Infantil, Centro Internacional de Arritmias, Bogotá, Colombia; Universidad de la Sabana, Chía, Columbia
| | - Alexandr R Chasnoits
- Department of Roentgen-Endovascular Surgery, Republican Scientific and Practical Centre Cardiology, Minsk, Belarus
| | - Dejia Huang
- Department of Cardiovascular Medicine, West China Hospital, Cardiology, Chengdu, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, Fuwai Cardiovascular Hospital, Beijing, China
| | - Janet E O'Brien
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, Minnesota, USA
| | - Daniel R Lexcen
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, Minnesota, USA
| | - Jeffrey Cerkvenik
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, Minnesota, USA
| | - Brian Van Dorn
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, Minnesota, USA
| | - Chi-Keong Ching
- Department of Cardiology, National Heart Centre of Singapore, Outram District, Singapore
| |
Collapse
|
34
|
Sumphaongern T, Yamahara E, Wakita R. Sudden Cardiac Arrest in a Dental Patient Awaiting Examination. Anesth Prog 2023; 70:25-30. [PMID: 36995959 PMCID: PMC10069538 DOI: 10.2344/anpr-69-04-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 09/16/2022] [Indexed: 03/31/2023] Open
Abstract
Sudden cardiac arrest (SCA) is an uncommon event in dental practice; however, the frequency of dentists encountering SCA and other major medical emergencies is increasing. We report the successful resuscitation of a patient who developed SCA while awaiting examination and treatment at a dental hospital. The emergency response team was called upon, and cardiopulmonary resuscitation/basic life support (CPR/BLS), including chest compression and mask ventilation, was promptly initiated. An automated external defibrillator was used, which indicated that the patient's cardiac rhythm was unsuitable for electrical defibrillation. The patient returned to spontaneous circulation after 3 cycles of CPR and intravenous epinephrine. The knowledge and skill levels of dentists regarding resuscitation under emergency circumstances should be addressed. Emergency response systems must be well established, and CPR/BLS knowledge and training should be updated regularly, including optimal management of both shockable and nonshockable rhythms.
Collapse
Affiliation(s)
- Thunshuda Sumphaongern
- Instructor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Erika Yamahara
- Graduate Research Student, Department of Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Wakita
- Associate Professor, Department of Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
35
|
Kim YG, Roh SY, Jeong JH, Lee HS, Min K, Choi YY, Han KD, Shim J, Choi JI, Kim YH. Long-term increase in fasting blood glucose is associated with increased risk of sudden cardiac arrest. Cardiovasc Diabetol 2023; 22:38. [PMID: 36805666 DOI: 10.1186/s12933-023-01764-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with various cardiovascular complications, including sudden cardiac arrest (SCA). Furthermore, the severity of DM, as assessed by fasting blood glucose (FBG), is associated with the risk of SCA. However, whether long-term changes in FBG influence on SCA risk remains to be determined. METHODS This study used sequential nationwide health screening data from 2009 and 2011. FBG was measured at each health screening, and ΔFBG was calculated as FBG in 2011-FBG in 2009. RESULTS Overall, 2,801,153 people were analyzed, and the mean follow-up duration was 6.33 years. Compared with the euglycemic group (- 20 ≤ ΔFBG < 20), the 20 ≤ ΔFBG < 40, 40 ≤ ΔFBG < 100, and ΔFBG ≥ 100 groups had increased SCA risks of 25% (adjusted hazard ratio [HR] = 1.25; 95% confidence interval [CI] 1.16-1.35; p < 0.001), 66% (adjusted HR = 1.66; 95% CI 1.49-1.86; p < 0.001), and 2.9-fold (adjusted HR = 2.85; 95% CI 2.37-3.44; p < 0.001), respectively. The association between ΔFBG and SCA was maintained in people with DM but not in people without DM. However, sex, age, blood pressure, and presence of heart failure did not affect the association between ΔFBG and SCA. A decrease in ΔFBG over time was not associated with reduced risk of SCA: the adjusted HR was 1.11 (95% CI 0.98-1.27; p = 0.113) for the ΔFBG < -40 group and 1.12 (95% CI 1.03-1.22; p = 0.009) for the - 40 ≤ ∆FBG < - 20 group. CONCLUSIONS A long-term increase in ΔFBG can be associated with increased risk of SCA in people with DM. However, a long-term decrease in ΔFBG was not associated with reduced risk of SCA. Actions to prevent increase in FBG can have significant effects on public health in terms of SCA prevention.
Collapse
|
36
|
Kim YG, Jeong JH, Han KD, Roh SY, Min K, Lee HS, Choi YY, Shim J, Choi JI, Kim YH. Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus. Cardiovasc Diabetol 2023; 22:36. [PMID: 36803488 PMCID: PMC9940386 DOI: 10.1186/s12933-023-01769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Dyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population. METHODS This study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code. RESULTS A total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70 mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160 mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160 mg/dL) followed by lowest LDL-cholesterol group (< 70 mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins. CONCLUSIONS In people with diabetes, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Low LDL-cholesterol level can be a surrogate marker for increased risk of SCA in people with diabetes mellitus and this paradoxical association should be recognized and extended to clinical preventive measures.
Collapse
Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, 73 Goryeodae-Ro, Seongbuk-Gu, 02841
| |
Collapse
|
37
|
Markush D, Sanchez-Lara PA, Grand K, Wong R, Garg R. Sudden Cardiac Arrest During a Sedated Cardiac Magnetic Resonance Study in a Nonsyndromic Child with Evolving Supravalvar Aortic Stenosis Due to Familial ELN Mutation. Pediatr Cardiol 2023; 44:946-950. [PMID: 36790509 PMCID: PMC10063468 DOI: 10.1007/s00246-022-03089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/22/2022] [Indexed: 02/16/2023]
Abstract
Supravalvar aortic stenosis (SVAS) is a less common but clinically important form of left ventricular outflow tract obstruction, and commonly associated with Williams syndrome (WS). SVAS outside of WS may also occur sporadically or in a familial form, often with identifiable mutations in the elastin (ELN) gene. While risk of sudden cardiac death in patients with SVAS has been extensively described in the context of WS, less is known about risk in patients with isolated SVAS. We report a case of a nonsyndromic two-year-old boy with evolving manifestations of SVAS who developed sudden cardiac arrest and death during a sedated cardiac magnetic resonance imaging study. A strong family history of SVAS was present and targeted genetic testing identified an ELN gene mutation in the boy's affected father and other paternal relatives. We review risk factors found in the literature for SCA in SVAS patients and utilize this case to raise awareness of the risk of cardiac events in these individuals even in the absence of WS or severe disease. This case also underscores the importance of genetic testing, including targeted panels specifically looking for ELN gene mutations, in all patients with SVAS even in the absence of phenotypic concerns for WS or other genetic syndromes.
Collapse
Affiliation(s)
- Dor Markush
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katheryn Grand
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Wong
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ruchira Garg
- Guerin Family Congenital Heart Program, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
38
|
Verheul LM, Groeneveld SA, Tuinenburg AE, Hassink RJ. Atrial fibrillation begets ventricular fibrillation when the AV node fails. J Electrocardiol 2023; 76:66-70. [PMID: 36442389 DOI: 10.1016/j.jelectrocard.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Deterioration of atrial fibrillation into ventricular fibrillation has frequently been described in patients with pre-excitation of the ventricles. We report two cases of atrial fibrillation without pre-excitation leading to rapid ventricular tachycardias and recurrent implantable cardioverter defibrillator therapy in young idiopathic ventricular fibrillation patients.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
39
|
Bassi MD, Farina JM, Bombau J, Fitz Maurice M, Bortman G, Nuñez E, Márquez M, Bornancini N, Baranchuk A. Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators). Arrhythm Electrophysiol Rev 2023; 12:e03. [PMID: 36845166 PMCID: PMC9945480 DOI: 10.15420/aer.2022.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023] Open
Abstract
Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.
Collapse
Affiliation(s)
- Mario D. Bassi
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - Juan M. Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona, US
| | - Jorge Bombau
- Internal Medicine, National University of La Plata, Argentina
| | - Mario Fitz Maurice
- Department of Cardiology, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Elaine Nuñez
- Servicio de Cardiología, Cedimat Centro Cardiovascular, Santo Domingo, República Dominicana
| | - Manlio Márquez
- Department of Electrophysiology, Centro Médico ABC (American British Cowdray), Ciudad de México, México
| | - Norberto Bornancini
- Department of Cardiology, Hospital General de Agudos “General Manuel Belgrano”, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada,Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
40
|
Goh AXC, Ho AFW. Correspondence: is there an association between centre volume and survival or neurological outcomes among out-of-hospital cardiac arrest patients? BMC Emerg Med 2022; 22:197. [PMID: 36494626 PMCID: PMC9737739 DOI: 10.1186/s12873-022-00743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
This commentary discusses the findings of a study by Tsuchida et al. on the effect of annual hospital admissions of out-of-hospital cardiac arrest patients on survival and neurological outcomes in OHCA patients in the context of existing literature on the topic, and the implications on future studies investigating the volume-outcome relationship in cardiac arrest.
Collapse
Affiliation(s)
- Amelia Xin Chun Goh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597 Singapore
| | - Andrew Fu Wah Ho
- grid.163555.10000 0000 9486 5048Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
41
|
Hardeland C, Leonardsen AL, Isern CB, Berge HM. The aftermath of surviving a sudden cardiac arrest for young exercisers - a qualitative study in Norway. BMC Health Serv Res 2022; 22:1452. [PMID: 36451196 DOI: 10.1186/s12913-022-08674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional effects of surviving may be present for months or years. The survivors' family and colleagues are also highly affected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. METHODS The study had a qualitative design, conducting in-depth individual interviews with SCA survivors < 50 years of age reporting to exercise ≥ 5 h/week and/or who suffered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. RESULTS 18 of 31 eligible participants were included in the study. Through analysis we identified 'Establishing a new everyday life' as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! CONCLUSION This study adds knowledge about young and regular exercisers' experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have persistent challenges that cause frustration and reduced quality of life.
Collapse
|
42
|
Wu MH, Wang JK, Chiu SN, Lu CW, Lin MT, Chen CA, Tseng WC. Long-term outcome of repaired tetralogy of Fallot: Survival, tachyarrhythmia, and impact of pulmonary valve replacement. Heart Rhythm 2022; 19:1856-1863. [PMID: 35781043 DOI: 10.1016/j.hrthm.2022.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) is recommended for severe pulmonary regurgitation in repaired tetralogy of Fallot (rTOF). OBJECTIVE The purpose of this study was to investigate the event rate and effectiveness of PVR. METHODS A retrospective study of tetralogy of Fallot patients who survived total repair from 1970 to 2020 was conducted. RESULTS We identified 1744 rTOF patients; 86.6% with classic rTOF, 11.5% with pulmonary atresia, 0.8% with endocardial cushion defect, and 1.1% with absent pulmonary valve. Annual risks of tachyarrhythmia/sudden cardiac arrest (SCA) increased to 0.295% and 1.338% in patients aged 10-30 and 30-60 years, respectively, without sex predominance. PVR (223 surgical and 39 percutaneous) event rate was 34.7% ± 2.1% by 30 years after repair (annual risk: 1.57% between 10 and 30 years after repair). The second PVR rate was 9.9% ± 4.1% by 20 years after the first PVR. Tachyarrhythmia/SCA risk was higher in PVR patients than in No PVR patients and was reduced in PVR patients without tachyarrhythmia/SCA before PVR. However, survival in patients with ventricular tachyarrhythmia/SCA still was better after PVR. At PVR, 13% of patients had tachyarrhythmia/SCA, which was the major predictor of events after PVR. Before PVR, although the ventricular tachyarrhythmia/SCA risks included QRS duration >160 ms and New York Heart Association functional class III or IV, supraventricular tachyarrhythmia was associated with PVR age ≥28 years and N-terminal pro-brain natriuretic peptide >450 pg/mL. CONCLUSION Tachyarrhythmia/SCA occurrence and the need for PVR increased with age during young adulthood. PVR reduced subsequent arrhythmias only in those patients without arrhythmias before PVR.
Collapse
Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Sheunn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
43
|
Chu CH, Shih HM, Yu SH, Chang SS, Sie JS, Huang FW, Hsu TY. Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study. BMC Emerg Med 2022; 22:169. [PMID: 36280807 PMCID: PMC9590157 DOI: 10.1186/s12873-022-00732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization. Methods We retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients’ demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders. Results A total of 920 patients with STEMI and coronary angiography–documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients’ demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI. Conclusions Left main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- Chang-Hung Chu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Hong-Mo Shih
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
| | - Shao-Hua Yu
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan
| | - Shih-Sheng Chang
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Division of Cardiovascular Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Ji-Syuan Sie
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Fen-Wei Huang
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Tai-Yi Hsu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
| |
Collapse
|
44
|
Agarwal S, Birk JL, Abukhadra SL, Rojas DA, Cornelius TM, Bergman M, Chang BP, Edmondson DE, Kronish IM. Psychological Distress After Sudden Cardiac Arrest and Its Impact on Recovery. Curr Cardiol Rep 2022; 24:1351-1360. [PMID: 35921024 PMCID: PMC9561080 DOI: 10.1007/s11886-022-01747-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the prevalence, correlates, and health consequences of poor mental health in the increasingly sizable population of survivors of Sudden cardiac arrest (CA) and to describe current intervention research in this area. RECENT FINDINGS After CA many patients report high psychological distress, including depression, generalized anxiety, and posttraumatic stress. Emerging evidence suggests that distressed patients' attention may narrow such that anxious awareness of afferent cardiac signals e.g., changes in heart rate or blood pressure, becomes predominant and a cause for concerned, constant monitoring. This cardiac-specific anxiety followed by behavioral avoidance and physiological hyperreactivity may increase patients' already high risk of secondary cardiovascular disease and undermine their health-related quality of life (HRQoL). Unlike other cardiovascular diseases, no clinical practice guidelines exist for assessing or treating psychological sequelae of CA. Future research should identify modifiable psychological targets to reduce secondary cardiovascular disease risk and improve HRQoL.
Collapse
Affiliation(s)
- Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA.
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Sabine L Abukhadra
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Danielle A Rojas
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY, 8GS-300, USA
| | - Talea M Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Maja Bergman
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, USA
| | - Donald E Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, USA
| |
Collapse
|
45
|
Dougherty CM, Liberato ACS, Streur MM, Burr RL, Kwan KY, Zheng T, Auld JP, Thompson EA. Physical function, psychological adjustment, and self-efficacy following sudden cardiac arrest and an initial implantable cardioverter defibrillator (ICD) in a social cognitive theory intervention: secondary analysis of a randomized control trial. BMC Cardiovasc Disord 2022; 22:369. [PMID: 35948889 PMCID: PMC9364545 DOI: 10.1186/s12872-022-02782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical and psychological function. The purpose of the study was to compare recovery across the first year between SCA survivors and other arrhythmia patients who received a first-time implantable cardioverter defibrillator (ICD) for secondary prevention, participating in a social cognitive theory (SCT) intervention. METHODS 168 (129 males, 39 females) who received an ICD for secondary prevention (SCA N = 65; other arrhythmia N = 103) were randomized to one of two study conditions: SCT intervention (N = 85) or usual care (N = 83). Outcomes were measured at baseline hospital discharge, 1, 3, 6, & 12 months: (1) Physical Function: Patient Concerns Assessment (PCA), SF-36 (PCS); (2) Psychological Adjustment: State Trait Anxiety (STAI), CES-D depression, SF-36 (MCS); (3) Self-Efficacy: Self-Efficacy (SCA-SE), Self-management Behaviors (SMB), Outcome Expectations (OE). Outcomes were compared over 12 months for intervention condition x ICD indication using general estimating equations. RESULTS Participants were Caucasian (89%), mean age 63.95 ± 12.3 years, EF% 33.95 ± 13.9, BMI 28.19 ± 6.2, and Charlson Index 4.27 ± 2.3. Physical symptoms (PCA) were higher over time for SCA survivors compared to the other arrhythmia group (p = 0.04), ICD shocks were lower in SCA survivors in the SCT intervention (p = 0.01); psychological adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention over 6 months, which improved at 12 months (p = 0.05); outcome expectations (OE) were significantly lower for SCA survivors in the SCT intervention (p = 0.008). CONCLUSIONS SCA survivors had greater number of physical symptoms, lower levels of mental health and outcome expectations over 12 months despite participation in a SCT intervention. Trial registration Clinicaltrials.gov: NCT04462887.
Collapse
Affiliation(s)
- Cynthia M. Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
- Evidera PPD, London, England, UK
| | - Megan M. Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Robert L. Burr
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ka Yee Kwan
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Tao Zheng
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Jon P. Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Elaine A. Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| |
Collapse
|
46
|
Eroglu TE, Coronel R, Zuurbier CJ, Blom M, de Boer A, Souverein PC. Use of sodium-glucose cotransporter-2 inhibitors and the risk for sudden cardiac arrest and for all-cause death in patients with type 2 diabetes mellitus. Eur Heart J Cardiovasc Pharmacother 2022; 9:18-25. [PMID: 35894858 PMCID: PMC9780744 DOI: 10.1093/ehjcvp/pvac043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/06/2022] [Accepted: 07/24/2022] [Indexed: 12/27/2022]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic agents that can have direct cardiac effects by impacting on cardiac ion transport mechanisms that control cardiac electrophysiology. We studied the association between SGLT-2i use and all-cause mortality and the risk of sudden cardiac arrest (SCA) in patients with type 2 diabetes. METHODS Using data from the UK Clinical Practice Research Datalink, a cohort study among patients initiating a new antidiabetic drug class on or after January 2013 through September 2020 was conducted. A Cox regression with time-dependent covariates was performed to estimate the hazard ratios (HRs) of SCA and all-cause mortality comparing SGLT-2is with other second- to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥5 years), and the presence of cardiovascular disease. RESULTS A total of 152 591 patients were included. Use of SGLT-2i was associated with a reduced HR of SCA when compared with other second- to third-line antidiabetic drugs after adjustment for common SCA risk factors, although this association marginally failed to reach statistical significance [HR: 0.62, 95% confidence interval (95% CI): 0.38-1.01]. The HR of all-cause mortality associated with SGLT-2i use when compared with other second- to third-line antidiabetics was 0.43 (95% CI: 0.39-0.48) and did not vary by sex, diabetes duration, or the presence of cardiovascular disease. SGLT-2i use remained associated with lower all-cause mortality in patients without concomitant insulin use (HR: 0.56, 95% CI: 0.50-0.63). CONCLUSION SGLT-2i use was associated with reduced all-cause mortality in patients with type 2 diabetes. The association between use of SGLT-2i and reduced risk of SCA was not statistically significant.
Collapse
Affiliation(s)
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Coert J Zuurbier
- Department of Anaesthesiology, Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam UMC, Location Academic Medical Centre (AMC), University of Amsterdam, Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Marieke Blom
- General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, 1105 BP Amsterdam, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| |
Collapse
|
47
|
Dean PN, Pugh K, Statuta SM, MacKnight JM. The Importance of Surrounding the Athlete's Heart with a Team. Clin Sports Med 2022; 41:357-368. [PMID: 35710266 DOI: 10.1016/j.csm.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Providing medical care for an athlete can be challenging in many aspects. One specific aspect is the athlete's cardiovascular system. Athletic training and physical activity certainly can improve cardiovascular health, but it can also cause cardiac adaptations and place athletes at risk for sudden cardiac arrest. When an athlete has cardiac symptoms, a concerning family history, abnormal cardiac testing, or an underlying cardiac condition, a wide range of professionals are needed to appropriately care for the athlete under evaluation.
Collapse
Affiliation(s)
- Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia School of Medicine, UVA Children's Hospital Battle Building, 1204 West Main Street, Charlottesville, VA 22903, USA.
| | - Kelli Pugh
- University of Virginia, McCue Center, Room 112, 290 Massie Road, Charlottesville, VA 22904, USA
| | - Siobhan M Statuta
- Department of Family Medicine and Physical Medicine and Rehabilitation, University of Virginia School of Medicine, PO Box 800729, 1415 Jefferson Park Avenue- McKim Hall 3152, Charlottesville, VA 22908, USA
| | - John M MacKnight
- Internal Medicine & Orthopaedic Surgery, University of Virginia School of Medicine, University Physicians Clinic, UVA Health System, Box 800671, Charlottesville, VA 22908, USA
| |
Collapse
|
48
|
Abstract
Sudden cardiac death (SCD) is the leading cause of medical death in athletes; however, many studies are significantly flawed making an accurate estimation of risk difficult. Incidence studies need to have accurate case ascertainment, a defined study population, and should be stratified by both sex and age. The risk of SCA/d in college-aged males is 1 in 35,000 person-years, black males 1 in 18,000 person-years, and higher-risk sports include men's basketball, men's soccer, and American football. Inherited cardiomyopathies and electrical conditions account for ∼ 2/3 of off SCA/d and can be detected with an ECG. More research is needed to provide more granular estimates.
Collapse
Affiliation(s)
- Kimberly G Harmon
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA; Sports Medicine Center at Husky Stadium, 3800 Montlake Boulevard, Seattle, WA 98195, USA.
| |
Collapse
|
49
|
Silka MJ, Shah MJ, Silva JNA, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Corcia MCG, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Bergen NHV, Wackel PL. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary. Ann Pediatr Cardiol 2022; 15:323-346. [PMID: 36589659 PMCID: PMC9802608 DOI: 10.4103/0974-2069.361245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, New York
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, New York
| | | | | | | |
Collapse
|
50
|
Moa A, Tan T, Wei J, Hutchinson D, MacIntyre CR. Burden of influenza in adults with cardiac arrest admissions in Australia. Int J Cardiol 2022; 361:109-115. [PMID: 35490787 DOI: 10.1016/j.ijcard.2022.04.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac arrest is the least preventable burden of cardiovascular disease, as treatment depends on timely resuscitation. The incidence of sudden cardiac arrest (SCA) is high, contributing 10-20% of cardiovascular mortality globally. The influenza vaccine reduces the risk of acute cardiovascular events. Little is known about the relationship of influenza infection to cardiac arrest. METHODS This study aimed to determine the estimated rate of SCA hospitalisations attributable to influenza in Australian adults. A generalised-additive statistical model was applied in the study. Weekly counts of laboratory-confirmed influenza notifications were used as independent variables in the model. RESULTS Our estimates showed that the yearly rate of SCA hospitalisations varied, and a significant association with influenza was observed in some years in older adults aged 65 years and over. On average, the annual estimated SCA hospitalisations rate due to influenza in adults aged 50-64 years and ≥ 65 years were 0.7 (95%CI: 0.4, 1.1) and 5.3 (95%CI: 4.4, 6.2) per 100,000 population, respectively. CONCLUSION The association between influenza and SCA is evident in adults and the disease burden is significant in older people. Prevention of influenza by vaccination may reduce SCA.
Collapse
Affiliation(s)
- Aye Moa
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia.
| | - Timothy Tan
- School of Medical Science, UNSW, Sydney, Australia; Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia
| | - Jenny Wei
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia
| | | | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Sydney, Australia; School of Public Affairs, College of Public Service and Community Solutions, Arizona State University, USA
| |
Collapse
|