Young adult survivors of sudden cardiac arrest: Analysis of invasive evaluation of 22 subjects

doi:10.1016/0002-8703(89)90186-5

American Heart Journal

Volume 118, Issue 2, August 1989, Pages 281-287

https://doi.org/10.1016/0002-8703(89)90186-5 Get rights and content

Abstract

Twenty-two young adult (mean age 27.8 ± 5.3 years) survivors of sudden cardiac arrest underwent invasive cardiac assessment. Initial evaluation by cardiac catheterization, coronary angiography, and hemodynamic studies identified two groups of young survivors. The first consisted of 13 (60%) subjects who had definable structural cardiac or lung disease accountable for a cardiac arrest event. Dilated cardiomyopathy dominated this group. Mitral valve prolapse, hypertrophic cardiomyopathy, left ventricular hypertrophy, anomalous origin of the right coronary artery, and tetralogy of Fallot were also encountered. The second group included nine subjects (40%) with normal cardiac structure and normal hemodynamic parameters. Electrophysiologic testing demonstrated in three of these patients the presence of Wolff-Parkinson-White syndrome. The electrophysiologic studies had a higher yield in reproduction of life-threatening arrhythmias among the subjects in the second group as opposed to the first group. The observation that 10 subjects (45%) from both groups had preceding symptoms varying from palpitations and chest pain to syncope and recurrent cardiac arrest events, is in contradiction to previous findings in the literature and raises a question of appropriate evaluation of young adults with cardiac symptoms.

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Cited by (35)

Clinical Approach to Symptomatic and Asymptomatic Patients with Ventricular Pre-excitation
2020, Cardiac Electrophysiology Clinics
Citation Excerpt :
To identify a truly asymptomatic patient with this condition is difficult, as symptoms can include fleeting chest discomfort or mild palpitations; furthermore, around 10% of asymptomatic patients have unreported arrythmias documented on Holters or event monitors.2 This is mostly true of pediatric patients, and particularly disturbing is the observation that most asymptomatic children with aborted sudden cardiac death were, when closely reviewed, in fact symptomatic.3 It is possible that the higher incidence of SCD in children is partially because of their inability to verbalize symptoms.
Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-White Pattern: The Con Perspective
2015, Cardiac Electrophysiology Clinics
Citation Excerpt :
Despite the limitations of natural history studies as noted earlier, it seems that the risks of pediatric patients and adults differ, with the incidence of life-threatening symptoms in asymptomatic children with a WPW ECG pattern being much higher than in adults.1 Although most patients with WPW resuscitated from SCD have had prior symptoms,6,15,16 VF or a cardiac arrest may be the presenting event, particularly in the pediatric population,6,23,48 which may be because all asymptomatic adults with a WPW ECG pattern by definition have survived childhood without any symptoms, and therefore have a lower risk. Most life-threatening arrhythmia, both in adults and the pediatric population, is aborted.41,49
PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern: Developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS).
2012, Heart Rhythm
Citation Excerpt :
The mechanism of sudden death in patients with WPW syndrome is very rapid conduction of atrial flutter and AF, which provokes VF.33 Although most WPW patients resuscitated from a sudden cardiac death (SCD) event have had prior symptoms,4,33,34 VF or a cardiac arrest may be the sentinel event, particularly in children.2–4 The earliest evidence for higher risk in asymptomatic children was actually somewhat overlooked.
Electrophysiological evaluation of asymptomatic ventricular pre-excitation in children and adolescents
2005, International Journal of Cardiology
Background: Diagnostic assessment and treatment have been described in detail in symptomatic WPW syndrome, but little information exists about significance and prognosis of an incidentally found ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate, retrospectively, the role of electrophysiological study (EPS) in the assessment of the arrhythmic risk in asymptomatic patients with VPE. Material and Methods: Sixty-two asymptomatic children and adolescents (38 M/24 F, aged 9.8±5.1 years) referred to our Division between 1996 and 2002 for an incidentally found VPE underwent an EPS for arrhythmic risk stratification. The following parameters were examined: anterograde effective refractory period of the accessory pathway (AP), the 1-to-1 conduction over the AP, the inducibility of atrio-ventricular re-entrant tachycardia (AVRT) and the inducibility of atrial fibrillation (AF) with measurement of minimal RR between two consecutive preexcitated QRS complexes, the average RR interval of all cycles, and the percentage of preexcitated QRS complexes. Result: During the EPS, 36 patients (58.1%) experienced sustained SVT. The tachycardia was initiated in the basal state in 22 patients and after isoproterenol in the other 14. Orthodromic AVRT (cycle length 305.9±48.5 ms) was recorded in 29 patients. In three patients, both orthodromic and antidromic AVRT were recorded, with different cycle length (CL). Antidromic AVRT alone (CL 239.5±13.7 ms) was recorded in four patients. AF was recorded in nine patients: in six patients, it was recorded after the induction of orthodromic or antidromic AVRT, in the other three cases AF was the first and only arrhythmic event. The minimal RR between two consecutive pre-excitated QRS ranged between 250–230 ms (mean 237.5±9.6 ms). In the 26 patients who presented no induced sustained tachycardia in the EPS, the 1:1 conduction over the AP ranged between 210 and 600 ms (mean 279.6±75.2 ms). Conclusions: Electrophysiological evaluation remains the gold standard for assessing risk of life-threatening arrhythmias in patients with VPE. However, a high proportion of healthy children and adolescents with VPE can experience sustained AVRT and/or AF during EPS. These results raise questions about the necessity of an aggressive treatment approach to prevent those “rare” cases of sudden death.
Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias
1999, Heart and Lung: Journal of Acute and Critical Care
Objective: The purpose of this study was to describe the changes in perception of health status and quality of life from before treatment to 6 months after and the impact of uncertainty on these variables in survivors of life-threatening arrhythmia. Design and Setting: A descriptive correlational design at a large urban teaching hospital. Measures: We measured health status, quality of life, and uncertainty before treatment and 6 months after a life-threatening arrhythmia. Results: Survivors included 66 men and 15 women, 41 of whom received pharmacologic therapy and 36 of whom received an implantable cardioverter defibrillator (ICD), completed the Medical Outcomes Survey (SF-36), Ferrans and Powers Quality of Life Index (QLI), and the Mishel Uncertainty in Illness Scale (MUIS-C) before treatment and 6 months after. There were significant improvements in the mental and physical health composite summaries as measured by the SF36 (P < .01). Conversely, there were significant reductions in the overall score and specifically in socioeconomic and psychological/spiritual quality of life domains as measured by the QLI (P < .05). An increased perception of uncertainty was related to decreased perception of health status and quality of life at both measurement times, with higher correlations 6 months later. Conclusions: Survivors demonstrated improvements in perceived health status, although this did not appear to translate into improvements in the subjective domains of quality of life. The overall quality of life and the domains of psychological/spiritual state and socioeconomic status were lower 6 months after a life-threatening arrhythmia. Uncertainty had a significant impact on these perceptions, identifying an area for nursing interventions. (Heart Lung^® 1999;28:251-60.)
ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation)
1998, Journal of the American College of Cardiology

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^☆: Supported in part by grants HL-28130 (Dr. Myerburg) and HL-07436 (Drs. Topaz and Cox) from the National Institutes of Health, Bethesda, Md.

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Young adult survivors of sudden cardiac arrest: Analysis of invasive evaluation of 22 subjects☆

Abstract

Chest

J Am Coll Cardiol

Chest

Am Heart J

Am Heart J

Am Heart J

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Cardiac arrest and sudden cardiac death

Right ventricular cardiomyopathy: another cause of sudden death in the young (Editorial)

N Engl J Med

Myocardial infarction in two sisters less than 20 years old

JAMA