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

22 Citations (Scopus)

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 - 01-01-2014

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Ambulatory Electrocardiography
Sudden Cardiac Death
Tachycardia
Cardiac Arrhythmias
Bradycardia
Odds Ratio
Confidence Intervals
Torsades de Pointes
Mortality
Atrioventricular Block
Syncope
Ventricular Fibrillation
Ventricular Tachycardia
Heart Arrest
Chest Pain
Seizures
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Watanabe, Eiichi ; Tanabe, Teruhisa ; Osaka, Motohisa ; Chishaki, Akiko ; Takase, Bonpei ; Niwano, Shinichi ; Watanabe, Ichiro ; Sugi, Kaoru ; Katoh, Takao ; Takayanagi, Kan ; Mawatari, Koushi ; Horie, Minoru ; Okumura, Ken ; Inoue, Hiroshi ; Atarashi, Hirotsugu ; Yamaguchi, Iwao ; Nagasawa, Susumu ; Moroe, Kazuo ; Kodama, Itsuo ; Sugimoto, Tsuneaki ; Aizawa, Yoshifusa. / Sudden cardiac arrest recorded during Holter monitoring : Prevalence, antecedent electrical events, and outcomes. In: Heart Rhythm. 2014 ; Vol. 11, No. 8. pp. 1418-1425.
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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.",
author = "Eiichi Watanabe and Teruhisa Tanabe and Motohisa Osaka and Akiko Chishaki and Bonpei Takase and Shinichi Niwano and Ichiro Watanabe and Kaoru Sugi and Takao Katoh and Kan Takayanagi and Koushi Mawatari and Minoru Horie and Ken Okumura and Hiroshi Inoue and Hirotsugu Atarashi and Iwao Yamaguchi and Susumu Nagasawa and Kazuo Moroe and Itsuo Kodama and Tsuneaki Sugimoto and Yoshifusa Aizawa",
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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, Sugimoto, T & Aizawa, Y 2014, 'Sudden cardiac arrest recorded during Holter monitoring: Prevalence, antecedent electrical events, and outcomes', Heart Rhythm, vol. 11, no. 8, pp. 1418-1425. https://doi.org/10.1016/j.hrthm.2014.04.036

Sudden cardiac arrest recorded during Holter monitoring : Prevalence, antecedent electrical events, and outcomes. / Watanabe, Eiichi; Tanabe, Teruhisa; Osaka, Motohisa; Chishaki, Akiko; Takase, Bonpei; Niwano, Shinichi; Watanabe, Ichiro; Sugi, Kaoru; Katoh, Takao; Takayanagi, Kan; Mawatari, Koushi; Horie, Minoru; Okumura, Ken; Inoue, Hiroshi; Atarashi, Hirotsugu; Yamaguchi, Iwao; Nagasawa, Susumu; Moroe, Kazuo; Kodama, Itsuo; Sugimoto, Tsuneaki; Aizawa, Yoshifusa.

In: Heart Rhythm, Vol. 11, No. 8, 01.01.2014, p. 1418-1425.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sudden cardiac arrest recorded during Holter monitoring

T2 - Prevalence, antecedent electrical events, and outcomes

AU - Watanabe, Eiichi

AU - Tanabe, Teruhisa

AU - Osaka, Motohisa

AU - Chishaki, Akiko

AU - Takase, Bonpei

AU - Niwano, Shinichi

AU - Watanabe, Ichiro

AU - Sugi, Kaoru

AU - Katoh, Takao

AU - Takayanagi, Kan

AU - Mawatari, Koushi

AU - Horie, Minoru

AU - Okumura, Ken

AU - Inoue, Hiroshi

AU - Atarashi, Hirotsugu

AU - Yamaguchi, Iwao

AU - Nagasawa, Susumu

AU - Moroe, Kazuo

AU - Kodama, Itsuo

AU - Sugimoto, Tsuneaki

AU - Aizawa, Yoshifusa

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

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

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