Rate Of Sudden Cardiac Arrest Research Articles

Incidence and predictors of sudden cardiac arrest in cardiac amyloidosis: a 5-year retrospective analysis

Abstract Background Despite recent advances in treatment, cardiac amyloidosis (CA) portends a poor outcome. Clinical manifestations of CA are variable and often nonspecific, which makes the diagnosis challenging. Failure to recognize early cardiac involvement may result in devastating complications such as sudden cardiac arrest (SCA). Electrocardiography (ECG) is a widely available and affordable modality that can aid with risk stratification. Purpose We aimed to study patient demographics and identify clinical and electrocardiographic (ECG) predictors of SCA in patients with CA. Methods We queried the Nationwide Inpatient Sample database between 2016–2020 to identify hospitalizations for CA who were then subcategorized based on SCA, using the ICD-10 diagnosis code. The primary outcome was to assess clinical and ECG predictors of SCA. Both groups were compared for association using the chi-square test, following which multivariate regression analysis was performed to identify predictors of SCA. In addition, we performed a temporal trends analysis of CA hospitalizations and SCA during this study period. Results A total of 103,620 weighted hospitalizations for CA were identified of which 1935(1.9%) suffered a SCA. Baseline characteristics and comorbidities were largely equivalent except for a history of heart failure which was significantly higher in the SCA group(63.3% vs 46.8%, p < 0.001). Interestingly, traditional cardiac risk factors like smoking, hypertension, diabetes, and obesity did not correlate with increased risk of SCA. African American (AA) race had a higher incidence of SCA(30.2% vs 23.4%, p < 0.001). A multivariate regression analysis was performed to identify predictors of SCA and account for potential clinical as well as demographic confounders. Higher rates of SCA were observed in male sex, age < 40 years, and AA race as outlined in figure 1. The presence of heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and tachyarrhythmias such as atrial fibrillation, atrial flutter, ventricular tachycardia and ventricular fibrillation were associated with significantly higher odds of SCA. In addition, right bundle branch block, left bundle branch block, first-degree AV block, complete heart block and fascicular blocks were independently predictive of higher rates of SCA. As expected, the rates of ICD implantation were higher in the SCA group (7.2% vs 0.9%, p < 0.001. There is an increasing trend in hospitalizations for cardiac amyloidosis from 2017 to 2020 as highlighted in figure 2. Conclusion Among patients with cardiac amyloidosis, young age, AA race, ECG evidence of AV nodal dysfunction, distal conduction disease, and tachyarrhythmias is associated with an elevated risk of SCA. These findings could improve risk stratification, prompt further targeted evaluation with advanced imaging modalities and help in early identification of amyloid patients with cardiac involvement.Figure 1Figure 2

Dissecting the mechanisms by which a pathogenic variant in cardiac TnT tail domain leads to disturbed myofilament performance.

Missense variant Ile79Asn in human cardiac troponin T (cTnT-I79N) has been associated with hypertrophic cardiomyopathy and high rate of sudden cardiac arrest at juvenile age. cTnT-I79N is located in the cTnT N-terminal (TNT1) loop region and is well-known for its pathological and prognostic relevance. Recent structural study revealed that I79 is part of hydrophobic interface between TNT1 loop and actin which stabilizes the OFF state of the cardiac thin filament. Given the importance of understanding: i) the role of TNT1 loop region on the regulation of the cardiac thin filament, and ii) the underlying mechanisms of cTnT-I79N-linked pathogenesis; we sought to investigate the effects of cTnT-I79N on cardiac myofilament function. Transgenic I79N (Tg-I79N) muscle bundles displayed increased passive force and passive sinusoidal stiffness, which could be due in part to an increase in force-generating cross-bridges during diastole. Tg-I79N also displayed increased myofilament Ca2+-sensitivity, shorter myofilament lattice spacing, and slower cross-bridge kinetics. These findings can be attributed to the destabilization of cardiac thin filament's inhibitory property, and the increase in the overall number of cross-bridges during Ca2+ activation. Finally, we show that cTnT-I79N dysregulates SRX↔DRX equilibrium, which can be explained by the excessive binding of myosin heads to the dysregulated thin filament that causes the SRX↔DRX equilibrium to shift towards the ON state. Altogether, biochemical and functional measurements, and structural data points to the following mechanism: cTnT-I79N weakens the interaction of the TNT1 loop with the actin filament, which in turn destabilizes the OFF state of the cardiac thin filament.

Abstract 14599: Survival From Sudden Cardiac Arrest During the COVID-19 Pandemic: Two-Year Prospective Evaluation in a Large US Community

Background: Early experience in the COVID-19 pandemic indicated higher rates of out-of-hospital sudden cardiac arrest (SCA) and worse outcomes. There is little data from subsequent surges of Delta and Omicron variants. Hypothesis: All surges in the COVID-19 pandemic affected SCA incidence and outcomes. Methods: In Ventura County CA (pop. 848,112), all SCA cases with likely cardiac etiology and resuscitation attempted by emergency medical services (EMS) were prospectively identified (2015-). Comparisons were conducted between two years of the pandemic period (Feb 1, 2020-Jan 31, 2022) and the corresponding 2y pre-pandemic period (2018-2020) and during COVID surges (>3000 COVID cases / month in the county) vs. non-surge times during the pandemic (<3000 cases / month). COVID monthly incidence was obtained from US CDC data (Fig. red curve). Results: Pre-pandemic there were 671 SCA cases (40/100,000, mean age 70.9 yrs, 63% male) with an increase in the pandemic period (p<0.001) to 894 cases (53/100,000, mean age 69.6 yrs, 65% male). During the pandemic there was significant reduction in SCA survival (16.4% to 9.1%, p <0.001). Survival decreased consistently with each COVID surge. The mean SCA survival during surges (Fig. blue curve) was significantly lower than pre-pandemic (6.3% vs 16.4% dotted blue curve, p <0.001) as well as during non-surge periods (6.3% vs 11.4%, p=0.008). Comparing pre-pandemic to COVID surge periods, the proportion of SCA calls with ambulance response time < 4 min declined from 27.1% to 9.4% (p<0.001) as did the proportion of SCAs with shockable rhythm (26.2% to 18.6%, p=0.004), and bystander CPR (56.9% to 47.9%, p=0.004). Conclusion: SCA rates continue to be higher during the COVID-19 pandemic with persisting significant reductions in survival outcomes at 2y, that are exaggerated during each surge. These findings have implications for ongoing community public health and EMS response planning during the pandemic.

Trends, Prevalence, and Outcomes of Sudden Cardiac Arrest Post Cardiac Transplant: A Nationwide 16-Year Study.

Heart transplantation is the most effective long-term therapy for end-stage heart disease. There is limited data related to sudden cardiac arrest (SCA) in postheart transplant recipients. We aimed to describe the trends, and rate of SCA following heart transplantation and thereby identify clinical predictors as well as outcomes of SCA in patients post-transplant. We queried the National Inpatient Sample (NIS) with administrative codes for SCA and heart transplant. We assessed baseline differences between SCA and non-SCA admissions, with hazard ratios adjusted for age, gender, CCI, and race. Multivariable logistic regression models were generated to identify the independent predictors for SCA. There was a total of 30,020 hospitalizations of heart transplant recipients between 1999 and 2014 in the United States and among these 1,953 patients (6.5%) suffered SCA with an increasing trend of admissions for SCA. Among the patients who suffered from SCA, 18.83% died during the same hospitalization, 19.29% were discharged to a long-term facility, and 61.38% were discharged home. Multivariate analysis demonstrated that conduction system disorders (Hazard ratio [95% confidence interval]; 7.1 [4.5-11.1]), female gender (HR:1.2 [1.1-1.3]), diabetes (HR:1.4 [1.2-1.6]), and hypertension (HR:1.2 [1.1-1.4]) were the strongest predictors for SCA. SCA hospitalizations occur in 6.5% of patients post cardiac transplant and have been increasing from 1999 to 2014. Conduction block, graft rejection, female gender, hypertension, diabetes are independent predictors for SCA in heart transplant recipients.

Epidemiology of sudden cardiac death and sudden cardiac arrest with resultant disability during high school organized sport in Japan

ObjectivesTo examine the incidence and survival rates of sudden cardiac arrest that were documented during school organized sports in Japan. DesignRetrospective cohort study. MethodsInsurance claim data of cardiac events (sudden cardiac death and sudden cardiac arrest with resultant disabilities) that occurred during Japanese high school organized sports between 2009 and 2018 were retrieved. Participation data from All Japan High School Athletic Federation and Japan High School Baseball Federation were used for incidence rate calculations. Incidence rate ratios with 95 % confidence interval were calculated to compare the risk by sports and sex. The survival rate was calculated with the proportion of resuscitated cases to total number of cardiac events in this dataset. ResultsA total of 55 cardiac events (25 survivors and 30 deceased) were identified in the dataset. The majority affected male student-athletes (92.7 %). The frequency and incidence rate of cardiac events were highest in male baseball (n = 16 [29.1 %], incidence rate: 0.91 per 100,000 athlete-years). Incidence rate ratio revealed that male basketball (2.19, 95 % confidence interval: 1.04–4.60), male baseball (2.31, 95 % confidence interval: 1.32–4.03), and first-year male baseball (4.11, 95 % confidence interval: 2.10–8.07) had significantly higher risk of cardiac events, compared to the overall incidence rate (0.38 per 100,000 athlete-years). The survival rates were 37.5 % in the first half (2009–2013) and 56.5 % in the latter half (2014–2018) of the study period. ConclusionsThe risk of cardiac events was highest in male, baseball, first-year student-athletes. Rapid AED application by bystanders should be advocated to enhance better survival.

Sudden cardiac arrest in patients with schizophrenia: A population-based study of resuscitation outcomes and pre-existing cardiovascular disease.

ObjectiveIndividuals with schizophrenia carry a high burden of cardiovascular disease and elevated rates of sudden cardiac arrest (SCA), but little published data is available regarding survival from SCA in this population. The authors compared cardiovascular disease burden and resuscitation outcomes following SCA in individuals with and without schizophrenia.MethodsCase-control analysis drawn from a prospective community-based study of SCA in a large community. The authors defined cases as having a pre-SCA history of schizophrenia, and controls as individuals with SCA without a history of schizophrenia. SCA cases with schizophrenia were compared to a 1:5 age- and sex-frequency-matched sample of SCA cases without schizophrenia.ResultsThe 103 SCA schizophrenia cases were as likely as the 515 cases without schizophrenia to have resuscitation attempted (75% vs. 80%; p = 0.24) and had a shorter 911 call mean response time (5.8 min vs. 6.9 min, p < 0.001). However, they were significantly less likely to present with a shockable rhythm (ventricular fibrillation/pulseless ventricular tachycardia 16% vs. 43%, p < 0.001), and less likely to survive to hospital discharge (3% vs. 14%, p = 0.008). Pre-arrest cardiovascular disease burden was similar in patients with and without schizophrenia.ConclusionsDespite comparable resuscitation characteristics and cardiovascular disease burden, patients with schizophrenia had significantly lower rates of SCA survival. The paucity of previous research into this phenomenon warrants further investigation to identify factors that may improve survival.

A Comprehensive Approach to Managing Methamphetamine-Associated Cardiomyopathy.

Methamphetamines are illicit drugs of the amphetamine-type stimulant class that have been increasing in popularity, availability, and purity in recent decades. As a result, rates of methamphetamine-associated cardiomyopathy (MAC) are rising globally. MAC is associated with high rates of sudden cardiac arrest, late presentation, and poor outcomes. This review discusses the medical management of MAC, including anticipated challenges specific to methamphetamine users. Not only are patients with MAC more likely to present at a younger age and with multisystem disease than patients with cardiomyopathy of other etiologies, but there may also be significant behavioral, psychosocial, financial, and system-based challenges to providing the best medical care. An individualized treatment plan that emphasizes methamphetamine abstinence as the foundation of therapy, as well as introducing optimal heart failure therapy and providing multidisciplinary support is likely to result in optimal outcomes. Given the potential reversibility of MAC, institution of guideline-directed heart failure therapy and patient support for adherence to therapy and abstinence from methamphetamines should be energetically pursued.

Evaluation of Sudden Cardiac Arrest by Race/Ethnicity Among Residents of Ventura County, California, 2015-2020

Sudden cardiac arrest (SCA) is a major public health problem. Owing to a lack of population-based studies in multiracial/multiethnic communities, little information is available regarding race/ethnicity-specific epidemiologic factors of SCA. To evaluate the association of race/ethnicity with burden, outcomes, and clinical profile of individuals experiencing SCA. A 5-year prospective, population-based cohort study of out-of-hospital SCA was conducted from February 1, 2015, to January 31, 2020, among residents of Ventura County, California (2018 population, 848 112: non-Hispanic White [White], 45.8%; Hispanic/Latino [Hispanic], 42.4%; Asian, 7.3%; and Black, 1.7% individuals). All individuals with out-of-hospital SCA of likely cardiac cause and resuscitation attempted by emergency medical services were included. Data on circumstances and outcomes of SCA from prehospital emergency medical services records and data on demographics and pre-SCA clinical history from detailed archived medical records, death certificates, and autopsies. Annual age-adjusted SCA incidence by race and ethnicity and SCA circumstances and outcomes by ethnicity. Clinical profile (cardiovascular risk factors, comorbidity burden, and cardiac history) by ethnicity, overall, and stratified by sex. A total of 1624 patients with SCA were identified (1059 [65.2%] men; mean [SD] age, 70.9 [16.1] years). Race/ethnicity data were available for 1542 (95.0%) individuals, of whom 1022 (66.3%) were White, 381 (24.7%) were Hispanic, 86 (5.6%) were Asian, 31 (2.0%) were Black, and 22 (1.4%) were other race/ethnicity. Annual age-adjusted SCA rates per 100 000 residents of Ventura County were similar in White (37.5; 95% CI, 35.2-39.9), Hispanic (37.6; 95% CI, 33.7-41.5; P = .97 vs White), and Black (48.0; 95% CI, 30.8-65.2; P = .18 vs White) individuals, and lower in the Asian population (25.5; 95% CI, 20.1-30.9; P = .006 vs White). Survival to hospital discharge following SCA was similar in the Asian (11.8%), Hispanic (13.9%), and non-Hispanic White (13.0%) (P = .69) populations. Compared with White individuals, Hispanic and Asian individuals were more likely to have hypertension (White, 614 [76.3%]; Hispanic, 239 [79.1%]; Asian, 57 [89.1%]), diabetes (White, 287 [35.7%]; Hispanic, 178 [58.9%]; Asian, 37 [57.8%]), and chronic kidney disease (White, 231 [29.0%]; Hispanic, 123 [40.7%]; Asian, 33 [51.6%]) before SCA. Hispanic individuals were also more likely than White individuals to have hyperlipidemia (White, 380 [47.2%]; Hispanic, 165 [54.6%]) and history of stroke (White, 107 [13.3%]; Hispanic, 55 [18.2%]), but less likely to have a history of atrial fibrillation (White, 251 [31.2%]; Hispanic, 59 [19.5%]). The results of this study suggest that the burden of SCA was similar in Hispanic and White individuals and lower in Asian individuals. The Asian and Hispanic populations had shared SCA risk factors, which were different from those of the White population. These findings underscore the need for an improved understanding of race/ethnicity-specific differences in SCA risk.

B-PO03-166 NIGHTTIME SUDDEN DEATH IN WOMEN

We recently reported that women are at increased risk for sudden cardiac arrest (SCA) at night. Especially since women tend to be older, social settings could contribute to these differences but have not been evaluated. We performed a sex-specific analysis of the circumstances and outcomes of SCA resuscitation at night to evaluate the potential role of differences in social settings. We studied adult out-of-hospital SCA cases from an ongoing prospective population-based study in the US Northwest (catchment population approx. 1 million, 2002-2016). SCA was defined as sudden collapse with loss of pulse likely due to a cardiac etiology that occurred during nighttime hours (9PM - 6AM). We performed a comprehensive analysis of circumstances, emergency medical response data and clinical records. Survivors of SCA and deceased patients were included. Of 4126 total SCA cases, 1076 occurred during nighttime hours, and 405 (37.7%) of these were women. Women with SCA at night were older than men (65.8±18.3 vs 63.6±17.5, p<0.001), were less likely to be witnessed (47.9% vs 54.2%, p=0.02), were more likely to be in a care facility (p<0.001), and were more likely to have Do Not Resuscitate (DNR) orders (13.1% vs 8.7%, p=0.04). Bystander CPR, response times, and survival to hospital discharge were not significantly different between men and women with SCA at night. Women with SCA at night are older, are more likely to have a DNR order, and have less witnessed cardiac arrest, possibly due to higher rates of living alone. In addition to sex-specific pathophysiology, social determinants of higher nighttime rates of SCA in women warrant further investigation.

The formation of a cardiac arrest registry in Australia [End unexplained cardiac death (EndUCP) registry

The End Unexplained Cardiac Death (EndUCD) Registry commenced in Victoria, Australia in April 2019. It is a multicentre cardiac arrest surveillance registry for patients aged 1 to 50 years. It is intended to expand into NSW and then other states of Australia. The key aims of the EndUCD Registry are to: 1)Provide a patient support resource, including website, patient-oriented information and streamlined referral process.2)Create a research platform for advocacy and improving understanding of accurate rates of sudden cardiac arrest/ death in patients aged 1–50 years old.3)Create a genetic biorepository as a resource for future studies.4)Provide a state-of-the-art resource for clinicians wishing to link cardiac arrest patients and families in with psychological support, comprehensive family screening and consideration of genetic testing. This presentation will examine the initial formation of the registry and present initial data from the first 2 years of collection and examine the role of forensic pathologist and forensic services in such a registry.

Atrial fibrillation and the risk of sudden cardiac arrest in patients with hypertrophic cardiomyopathy - A nationwide cohort study.

BackgroundHypertrophic cardiomyopathy (HCM), affecting 0.2% of the population, is the leading cause of sudden cardiac arrest (SCA). Incident atrial fibrillation (AF) is associated with an increased risk of SCA in general population. To determine whether AF is associated with an increased risk of SCA in patients with HCM.MethodsThis nationwide cohort study analyzed data from Registry for Catastrophic Illness, which encompassed almost 100% of the patients with HCM in Taiwan from 1996 to 2013. Follow-up and data analysis ended December 31, 2013. The main outcome was physician-adjudicated SCA, defined as death from a sudden, pulseless condition presumed due to a ventricular tachyarrhythmia. The secondary outcome was non-sudden cardiac death (NSCD), which was heart failure death, stroke death and non-HCM related death. We used Cox proportional hazards models to assess the association between AF and SCA/NSCD, adjusting for baseline demographic and cardiovascular risk factors.FindingsA total 10,910 subjects participated in this study with mean age of 62 years. Among enrolled subjects, 1,169 (10.7%) developed AF, which was independently associated with elder age, female sex, and history of heart failure (HF) hospitalization. During follow-up (median, 8.5 years and 2th to 7th interquartile range, 3.6 to 16.5 years), 371 SCA (166 in AF and 205 in non-AF group) and 797 NSCD (417 in AF and 380 in non-AF group) events occurred. The crude incidence rates of SCA were 12.45/1000 person-years (with AF) and 3.57/1000 person-years (without AF). The crude incidence rates for NSCD were 31.29/1000 person-years (with AF) and 6.63/1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CI) of AF for SCA and NSCD were 3.633 (2.756–4.791) and 2.086 (1.799–2.418), respectively. Furthermore, among the etiologies of NSCD, subjects with AF was at most risk of stroke-related death (HR, 6.609; 95% CI, 3.794–9.725).InterpretationIncident AF is associated with an increased risk of SCA and NSCD in the HCM population. Early detection of AF may provide more comprehensive risk stratification of SCD in HCM population. Because of underuse of oral anticoagulants and the absence of primary prevention ICD therapy in our cohort, the application of our findings was limited for the general HCM population in the current clinical practice.FundingNone

Abstract 17140: Impact of Atrial Fibrillation on the Outcomes of Heart Failure With Preserved Ejection Fraction- A National Inpatient Sample Based Study

Introduction: Atrial fibrillation (AF) adversely affect the outcomes in the patients of heart failure (HF) with reduced ejection fraction, however there are limited data exploring such an association in HF with preserved ejection fraction (HFpEF). Hypothesis: AF is associated with worse outcomes in HFpEF. Methods: We included all the patients with the primary diagnosis of HFpEF from the national inpatient sample (NIS) database (2012-2014) using ICD-9 codes. Exposure of interest was AF. Primary outcome was in-hospital mortality and secondary outcomes were rates of sudden cardiac arrest (SCA), syncope, cardiogenic shock, embolic stroke, acute myocardial infarction (AMI), acute kidney injury (AKI), passive hepatic congestion, ventricular fibrillation (V fib) and flutter, ventricular assist device (VAD), AICD, cardiac resynchronization therapy (CRT), intra-aortic balloon placement (IABP) placement and heart transplantation. Hospitalization cost was also studied. Results: Our study cohorts included 26,51,970 patients of HFpEF with AF and 37,44,101 patients of HFpEF without AF. AF cohort had more numbers of older patients and less female representation. In-hospital mortality was more in AF cohort. Similarly, the odds of SCA, cardiogenic shock, embolic stroke, passive hepatic congestion, Vfib and flutter, AICD and CRT placement were higher in AF cohort. The odds of syncope, AMI and AKI were lower in AF cohort as compared to non-AF cohort. While the odds of heart transplantation and VAD and IABP use remained comparable between the study cohorts, AF cohort incurred greater of cost of hospitalization. Conclusion: AF in HFpEF patients is associated with increased in-hospital mortality and cardiogenic shock and should be aggressively treated for improved outcomes.

Abstract 15038: Gender Differences Amongst Caucasians and African Americans in Rates of Arrhythmias, Implantable Cardiac Devices, and In-hospital Mortality in Sarcoidosis Patients With Cardiomyopathy

Introduction: The prevalence of sarcoid cardiomyopathy (SCM) with female predominance is well known. However, gender differences amongst individual races remains poorly studied. Hypothesis: We sought to determine and compare within each gender and race, the rates of arrhythmias, implantable cardiac devices, and in-hospital mortality in patients with SCM after excluding those with a history of coronary artery disease. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients &gt;18 years old. We combined it with code (425.8) for cardiomyopathy in other diseases including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results: From 2010 to 2014, we identified 9,063 patients with SCM (mean age = 53.11 ± 11.28 years; men 51.8% and black 52.5%). Upon comparison of gender within races, event rates per 100 patients were (white male, white female, black male, black female; p-value): atrial fibrillation (20.7, 18.8, 18, 16.1; p=0.172), ventricular fibrillation (VF) (4.1, 1.7, 2.3, 2.1; p&lt;0.001), ventricular tachycardia (VT) (33.1, 19.3, 25.1, 21; p&lt;0.001), complete heart block (CHB) (9.1, 8.6, 3.4, 3.6; p=0.58), second degree Mobitz type II (0.3, 0.35, 0.8, 0.4; p=0.717), implantable cardioverter-defibrillator (ICD) (13.3, 9.3, 8.4, 9.2; p&lt;0.001), cardiac resynchronization therapy defibrillator (CRT-D) (5.5, 1.4, 3.4, 2.5; p&lt;0.001), permanent pacemaker (PPM) (2.2, 4.1, 1.1, 1.6; p&lt;0.001), sudden cardiac arrest (SCA) (1.3, 1.7, 1.3, 2.4; p=0.34), endomyocardial biopsy (EMB) (3.6, 2.1, 1.9, 2.3; p=0.011), cardiac MRI (CMR) (1.4, 0.3, 0.7, 1.3; p=0.002), cardiogenic shock (2.5, 1.4, 3, 3; p=0.027), orthotopic heart transplantation (OHT) (2.3, 1.4, 1.1, 0.2; p=0.05), catheter ablation (8.3, 4.5, 3.8, 1.9; p&lt;0.001), and in-hospital mortality (1.7, 3, 2.9, 2.6; p=0.008). Conclusion: White males had higher rates of VF, VT, CHB, but they also had a lower in-hospital mortality and SCA rates likely due to higher procedural rates such as EMB, ICD, CRT-D, catheter ablation and OHT as compared to others.

Sarcoid heart disease: rates of arrhythmias, implantable cardiac devices and endomyocardial biopsy

Abstract Introduction/Background Sarcoidosis is a granulomatous disease with various cardiac manifestations such as arrhythmias, heart block, heart failure and sudden cardiac death. Objective We sought to determine and compare the rates of arrhythmias, implantable cardiac devices in patient with sarcoid heart disease (SHD) after excluding those with a history of coronary artery disease Methods The United States Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients &amp;gt;18 years. We combined it with code (425.8) for cardiomyopathy in others disease including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results From 2010 to 2014, we identified 9,063 patients with SHD (Mage = 53.11±11.28 years; men 51.8% and black 52.5%). The overall in-hospital mortality rate was 227 (2.5%). Average Length of stay (LOS) (M ± SD) was 6.15±8.964. Various arrhythmias include atrial fibrillation 1,659 (18.4%), ventricular fibrillation 223 (2.5%), ventricular tachycardia 2,248 (24.7%), complete heart block 506 (1.5%) and second degree Mobitz type II 45 (0.5%). Rates of implantable cardiac devices included implantable cardioverter-defibrillator (ICD) 881 (9.7%), Cardiac Resynchronization Therapy Defibrillator (CRT-D) 83 (3.6%), PPM 172 (1.9%). Rates of Endomyocardial biopsy were 257 (2.8%). Overall rates of sudden cardiac arrest was 161 (1.8%). On comparing the two groups, sarcoidosis without cardiac involvement and sarcoid heart disease the rates of arrhythmias, implantable cardiac devices, in-hospital mortality and sudden cardiac arrest were as follows: atrial fibrillation (9.4 vs 18.3; p&amp;lt;0.001), ventricular fibrillation (0.1 vs 2.5; p&amp;lt;0.001), ventricular tachycardia (1.3 vs 24.8; p&amp;lt;0.001), complete heart block were (0.3 vs 5.6; p&amp;lt;0.001), and second degree Mobitz type II (0.1 vs 0.5; p&amp;lt;0.001), Pacemaker (0.4 vs 1.9; p&amp;lt;0.001), ICD (0.2 vs 9.7; p&amp;lt;0.001), CRT-D (0.1 vs 3.6; p&amp;lt;0.001), in-hospital mortality (2.5 vs 2.5; p=0.8), Sudden cardiac arrest (0.6 vs 1.8; p&amp;lt;0.001). Conclusions Based on the results of our study, we conclude that SHD is associated with a variety of cardiac arrhythmias and conduction defects. Sarcoidosis with cardiac involvement is associated with increased rates of atrial fibrillation, ventricular fibrillation, ventricular tachycardia, complete heart block, and second degree Mobitz type II. They also had a higher rate of pacemaker implantation, ICD, CRT-D and had a overall higher rate of sudden cardiac arrest. Based on the results of our study we conclude that sarcoidosis with cardiac involvement has worse outcomes and hence, early diagnosis and prompt treatment can prevent the progression of the disease. Funding Acknowledgement Type of funding source: None

Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

Abstract Background Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population. Methods We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14). Conclusions Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse. Predictors of SCA in Adolescent MVP Funding Acknowledgement Type of funding source: None

PREDICTORS OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SARCOIDOSIS WITH CARDIOMYOPATHY

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: We sought to determine the predictors of in-hospital mortality using charlson co-morbidity variables among patients with sarcoidosis with cardiomyopathy (SCM) METHODS: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years. We combined it with code 425.8 for cardiomyopathy in other diseases including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. RESULTS: From 2010 to 2014, we identified 9,063 patients with SCM (Mean age = 53.11 ± 11.28 years; men 51.8% and black 52.5%). The overall in-hospital mortality rate was 2.5%. Various arrhythmias include atrial fibrillation (AF) 18.4%, ventricular fibrillation (VF) 2.5%, ventricular tachycardia (VT) 24.7%, complete heart block (CHB) 1.5% and second degree Mobitz type II 0.5%. Rates of implantable cardiac devices included implantable cardioverter-defibrillator (ICD) 9.7%, Cardiac Resynchronization Therapy Defibrillator (CRT-D) 3.6%, permanent pacemaker (PPM) 1.9%. Rate of endomyocardial biopsy (EMB) was found to be 2.8%. Rates of heart failure, cardiogenic shock, orthotropic heart transplantation (OHT), and catheter ablation were 100%, 2.6%, 1.4%, and 4.4%, respectively. Overall rate of sudden cardiac arrest (SCA) was found to be 1.8%. Based on a multivariate analysis, significant predictors of in-hospital mortality were age (AOR = 1.047, 95% CI [1.033, 1.061]), peripheral vascular disease (AOR = 0.297, 95% CI [0.173, 0.509]), COPD (AOR = 0.568, 95% CI [0.419, 0.771]), mild liver disease (AOR = 0.242, 95% CI [0.160, 0.367]), hemiplegia or paraplegia (AOR = 12.223, 95% CI [5.637, 26.506]), renal disease (AOR = 0.451, 95% CI [0.328, 0.619]), AF (AOR = 2.686, 95% CI [1.963, 3.675]), VF (AOR = 0.453, 95% CI [0.250, 0.821]), and SCA (AOR = 0.023, 95% CI [0.015, 0.036]). CONCLUSIONS: Patients with co-morbidities such as peripheral vascular disease, COPD, mild liver disease, hemiplegia or paraplegia, and renal disease were associated with higher in-hospital mortality. Among complications AF, VF, and SCA were predictors of in-hospital mortality. CLINICAL IMPLICATIONS: This study sheds light on clinical factors that could play a role in predicting mortality in patients with SCM. Possible identification and appropriate management of these factors may improve outcomes. DISCLOSURES: No relevant relationships by Abhijit Bhattaru, source=Web Response No relevant relationships by Akhil Gade, source=Web Response No relevant relationships by Karthik Gonuguntla, source=Web Response No relevant relationships by Pranav Karambelkar, source=Web Response No relevant relationships by Shivaraj Patil, source=Web Response No relevant relationships by Chaitanya Rojulpote, source=Web Response

GSTM3 variant is a novel genetic modifier in Brugada syndrome, a disease with risk of sudden cardiac death.

BackgroundBrugada syndrome (BrS) is a rare inherited disease causing sudden cardiac death (SCD). Copy number variants (CNVs) can contribute to disease susceptibility, but their role in Brugada syndrome (BrS) is unknown. We aimed to identify a CNV associated with BrS and elucidated its clinical implications.MethodsWe enrolled 335 unrelated BrS patients from 2000 to 2018 in the Taiwanese population. Microarray and exome sequencing were used for discovery phase whereas Sanger sequencing was used for the validation phase. HEK cells and zebrafish were used to characterize the function of the CNV variant.FindingsA copy number deletion of GSTM3 (chr1:109737011-109737301, hg38) containing the eighth exon and the transcription stop codon was observed in 23.9% of BrS patients versus 0.8% of 15,829 controls in Taiwan Biobank (P < 0.001), and 0% in gnomAD. Co-segregation analysis showed that the co-segregation rate was 20%. Patch clamp experiments showed that in an oxidative stress environment, GSTM3 down-regulation leads to a significant decrease of cardiac sodium channel current amplitude. Ventricular arrhythmia incidence was significantly greater in gstm3 knockout zebrafish at baseline and after flecainide, but was reduced after quinidine, consistent with clinical observations. BrS patients carrying the GSTM3 deletion had higher rates of sudden cardiac arrest and syncope compared to those without (OR: 3.18 (1.77–5.74), P<0.001; OR: 1.76 (1.02–3.05), P = 0.04, respectively).InterpretationThis GSTM3 deletion is frequently observed in BrS patients and is associated with reduced INa, pointing to this as a novel potential genetic modifier/risk predictor for the development of the electrocardiographic and arrhythmic manifestations of BrS.FundingThis work was supported by the Ministry of Science and Technology (107-2314-B-002-261-MY3 to J.M.J. Juang), and by grants HL47678, HL138103 and HL152201 from the National Institutes of Health to CA.

P5646Risk factor paradox in STEMI-related sudden cardiac arrest

Abstract Background Cardiovascular risk factors (CVRF) are associated with an increased risk of atherosclerosis and ST-segment elevation myocardial infarction (STEMI). Sudden cardiac arrest (SCA) is currently the most feared complication of STEMI. The impact of CVRF on the rate of SCA is still unknown. Purpose To assess the association between CVRF and pre-hospital SCA during acute STEMI. Methods Data were taken between 2006 and 2014 from the e-MUST study that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Characteristics of patients who presented SCA were compared to those of patients who did not, and multivariable logistic regression was developed including all variables that differed between the two groups, in order to identify characteristics associated with an increased risk of SCA. Results Over the study period, 13,253 STEMI patients were included (median age 60.1 [51.4 - 73.0], 78.1% males). Among them, 7,513 patients (58.1%) had ≥2 CVRF, 3,979 (30.8%) had 1 CVRF, and 1,432 (11.1%) did not present any CVRF. Pre-hospital SCA witnessed by emergency medical services occurred in 749 (5.6%) patients. SCA victims were younger compared to the non-SCA group (58.0 vs. 60.3 years (P&lt;0.001), with a higher proportion of patients without known CVRF (17.2 vs. 10.7%, P&lt;0.001). There was no statistical difference in sex ratio (77.5% vs. 78.2%, P=0.69) and presence of past history of coronary artery disease (18.7% vs. 19.5%, P=0.56). Patients with ≥2 CVRF had the lowest rate of SCA (4.6%), while the highest SCA rate occurred among patients without CVRF (8.9%). On multivariate analysis, the presence of ≥2 CVRF was associated with a twice-lower risk of SCA (OR 0.52, 95% CI 0.41–0.65, P&lt;0.001, when the group without risk factors was taken as a reference group). Conclusion The prevalence of CVRF is high among patients presenting STEMI. However, once STEMI has occurred, presence of CVRF is associated with a lower rate of SCA per STEMI, creating a risk factor paradox in STEMI-related SCA.

The prevention and management of sudden cardiac arrest in athletes

KEY POINTS Cardiac arrests that occur during sports competition are dramatic and unexpected, and attract much media interest, as athletes are often young and at the peak of physical fitness. The rate of sudden cardiac arrest during exercise in competitive athletes is about 0.75 per 100 000 athletes

Prevention of Sudden Death Related to Sport: The Science of Basic Life Support-from Theory to Practice.

The sudden cardiac arrest (CA) and death of athletes are dramatic and emotionally impacting events for health professionals, family, and society. Although the practice of sport participation improves general health, physical fitness, and quality of life, intense physical exercise can be a trigger for CA and sudden death occasionally in the presence of known or unknown cardiac disorders (mainly hypertrophic cardiomyopathy) and risk factors (environment, health style, family, and genetic). The present review found that sudden death associated with CA was not such a common event in competitive athletes, but it might be an underestimated event in recreational athletes. Thus, considering the exponential increase in sport participation, both in a recreational or competitive way, and the rate of sudden CA, knowledge of implementing prevention and treatment strategies is crucial. This includes preparation of health professionals and lay people in basic life support (BLS); screening and pre-participation assessment in sport programs and health education; and promotion for the recognition of CA and early completion of BLS and rapid access to automatic external defibrillator to improve the victim survival/prognosis. Thus, the purpose of this review is to provide for health professionals and lay people the most updated information, based on current guidelines, of how to proceed in an emergency situation associated with sudden CA of young adult athletes.