Victor Waldmann

Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation

Abstract Aims Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Methods and results Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80–22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12–12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Conclusion Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.

Electrical cardiac injuries: current concepts and management

Electrical injuries are a commonly encountered hazard in both the home and workplace. However, clinicians are often uncomfortable when faced with the patient who presents with an electric shock due to sparse literature and lack of systematic recommendations on this topic. Electrical injuries can range from minor skin burns to life threatening internal organ damage. A thorough clinical assessment to ascertain the path of current through the body and possible internal injury is essential. The main concern in an apparently stable individual after an electric shock is the potential for delayed occurrence of cardiac arrhythmias which will require monitoring in the intensive care setting. While it may be reasonable to discharge home from the emergency room selected patients with low voltage injuries, absence of syncope and a normal ECG, others may require monitoring for at least 24 h. Public education and increasing workplace as well as home safety measures are key steps in prevention. The present review summarizes current knowledge in pathophysiology, manifestations and management of electrical injuries, with specific focus on cardiac effects.

Etiological diagnoses of out-of-hospital cardiac arrest survivors admitted to the intensive care unit: Insights from a French registry☆

BACKGROUND Respective proportions of final etiologies are disparate in cohorts of cardiac arrest patients, depending on examined population and diagnostic algorithms. In particular, prevalence and characteristics of sudden unexplained death syndrome (SUDS) are debated. We aimed at describing etiologies in a large cohort of aborted out-of-hospital cardiac arrest (OHCA) patients, in order to assess prevalence and outcome of SUDS. PATIENTS AND METHODS We analyzed data from our prospective registry of successfully resuscitated OHCA patients admitted to a cardiac arrest centre between January 2002 and December 2014. The in-ICU diagnostic strategy included early coronary angiogram, brain and chest CT scan. This was completed by an extensive diagnostic strategy, encompassing biological and toxicological tests, repeated electrocardiograms and echocardiography, MRI and pharmacologic tests. Two independent investigators reviewed each final diagnosis. Baseline characteristics were compared between subgroups of patients. Three-month mortality was compared between subgroups using univariate Kaplan-Meier curves. RESULTS Over the study period, 1657 patients were admitted to our unit after an aborted OHCA. The event was attributed to a non-cardiac and a cardiac cause in 478 (32.0%) and 978 (65.5%) patients, respectively. The main cause of cardiac related OHCA was ischemic heart disease (76.7%) while primary electrical diseases accounted for only 2.5%. Sudden unexplained deaths (SUDS) were observed in 37 (2.5%) patients. CONCLUSION We observed that ischemic heart disease was by far the most common cause of cardiac arrest, while primary electrical diseases were much less frequent. SUDS accounted for a very small proportion of patients who suffered an aborted OHCA.

Holter-monitored sudden cardiac arrest after atrioventricular junction ablation: WALDMANN et al.

We present a case of sudden cardiac arrest 7 hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a “torsade de pointes.” This illustration underlines the need to program a relatively rapid ventricular rate first weeks after junction ablation, especially in case of rapid ventricular rate prior to the procedure, as well as the role of continuous ECG and QT interval monitoring during hospital stay.

Coronary Vasospasm-Related Sudden Cardiac Arrest in the Community

Emerging data suggest a significant risk for recurrent arrhythmic events after sudden cardiac arrest (SCA) related to coronary vasospasm (CVS) [(1,2)][1]. We aimed to assess the extent to which CVS-related SCA is investigated and managed in the real-world setting. The Paris-SDEC (Paris Sudden Death

Sudden Cardiovascular Arrest During Sexual Intercourse

Considerable apprehension often surrounds the issue of sudden cardiovascular arrest (SCA) during physical activity, especially that related to sexual intercourse. Sex-related SCA (SxSCA) has been mainly investigated through forensic studies, and epidemiological data are scarce.1 A comparison of the characteristics and outcomes of SxSCA with other SCAs may allow a better understanding of this dramatic condition. The Paris-SDEC registry (Paris-Sudden Death Expertise Center) has been described previously.2 In brief, it is an ongoing, prospective, population-based study in Paris and its suburbs (population 6.7 million). Since May 2011, every case of out-of-hospital SCA aged ≥18 years has been captured, and systematic information has been gathered. Appropriate institutional review boards approved the investigation with waiver of informed consent. Utstein templates and medical records were reviewed by 2 cardiologists. Data from all patients with SCA alive at hospital admission were analyzed. SxSCA was defined as any SCA occurring during coitus or within the following hour, and its characteristics were compared with SCA occurring during other physical activities (exercise-non SxSCA), and at rest (sedentary), as well. All patients admitted alive with a normal coronary angiogram and clinical evidence for a neurological issue systematically underwent a computed …