Sudden cardiac arrest recorded during Holter monitoring: Prevalence, antecedent electrical events, and outcomes

Eiichi Watanabe, Teruhisa Tanabe, Motohisa Osaka, Akiko Chishaki, Bonpei Takase, Shinichi Niwano, Ichiro Watanabe, Kaoru Sugi, Takao Katoh, Kan Takayanagi, Koushi Mawatari, Minoru Horie, Ken Okumura, Hiroshi Inoue, Hirotsugu Atarashi, Iwao Yamaguchi, Susumu Nagasawa, Kazuo Moroe, Itsuo Kodama, Tsuneaki SugimotoYoshifusa Aizawa

Research output: Contribution to journalArticle

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Abstract

Background Causative arrhythmias of sudden cardiac arrest (SCA) are changing in this age of improved coronary care. Objective The purpose of this study was to examine the frequency of terminal arrhythmias and the electrical events prior to SCA. Methods We analyzed 24-hour Holter recordings of 132 patients enrolled from 41 institutions who either died (n = 88) or had an aborted death (n = 44). The Holter recordings were obtained for diagnosing and evaluating diseases and arrhythmias in those without any episodes suggestive of SCA. Results In 97 patients (73%), SCA was associated with ventricular tachyarrhythmias and in 35 (27%) with bradyarrhythmias. The bradyarrhythmia- related SCA patients were older than those with a tachyarrhythmia-related SCA (70 ± 13 years vs 58 ± 19 years, P <.001). The most common arrhythmia for a tachyarrhythmia-related SCA was ventricular tachycardia degenerating to ventricular fibrillation (45%). The bradyarrhythmia-related SCA was caused by asystole (74%) or AV block (26%). Spontaneous conversion was observed in 37 patients (38%) with ventricular tachyarrhythmias. Of those, 62% of the patients experienced symptoms including syncope, chest pain, or convulsion. Multivariate logistic analysis revealed that independent predictors of mortality for tachyarrhythmia-related SCAs were advanced age (odds ratio 1.04, 95% confidence interval 1.02-1.08) and ST elevation within the hour before SCA (odds ratio 3.54, 95% confidence interval 1.07-13.5). In contrast, the presence of preceding torsades de pointes was associated with spontaneous conversion (odds ratio 0.20, 95% confidence interval 0.05-0.66). Conclusion The most frequent cause of SCA remains ventricular tachyarrhythmias. Advanced age and ST elevation before SCA are risk factors for mortality in tachyarrhythmia-related SCAs.

Original languageEnglish
Pages (from-to)1418-1425
Number of pages8
JournalHeart Rhythm
Volume11
Issue number8
DOIs
Publication statusPublished - 08-2014

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Watanabe, E., Tanabe, T., Osaka, M., Chishaki, A., Takase, B., Niwano, S., Watanabe, I., Sugi, K., Katoh, T., Takayanagi, K., Mawatari, K., Horie, M., Okumura, K., Inoue, H., Atarashi, H., Yamaguchi, I., Nagasawa, S., Moroe, K., Kodama, I., ... Aizawa, Y. (2014). Sudden cardiac arrest recorded during Holter monitoring: Prevalence, antecedent electrical events, and outcomes. Heart Rhythm, 11(8), 1418-1425. https://doi.org/10.1016/j.hrthm.2014.04.036