Sudden Cardiac Arrest In Adults Research Articles

Sudden cardiac arrest in patients with cancer in the general population: insights from the Paris-SDEC registry

BackgroundData on the management of patients with cancer presenting with sudden cardiac arrest (SCA) are scarce. We aimed to assess the characteristics and outcomes of SCA according to cancer history.MethodsProspective,...

Risk Factors for Sudden Cardiac Arrest Among Hispanic or Latino Adults in Southern California: Ventura PRESTO and HCHS/SOL.

Background Out-of-hospital sudden cardiac arrest (SCA) is a leading cause of mortality, making prevention of SCA a public health priority. No studies have evaluated predictors of SCA risk among Hispanic or Latino individuals in the United States. Methods and Results In this case-control study, adult SCA cases ages 18-85 (n=1,468) were ascertained in the ongoing Ventura Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO) study (2015-2021) in Ventura County, California. Control subjects were selected from 3033 Hispanic or Latino participants who completed Visit 2 examinations (2014-2017) at the San Diego site of the HCHS/SOL (Hispanic Community Health Survey/Study of Latinos). We used logistic regression to evaluate the association of clinical factors with SCA. Among Hispanic or Latino SCA cases (n=295) and frequency-matched HCHS/SOL controls (n=590) (70.2% men with mean age 63.4 and 61.2 years, respectively), the following clinical variables were associated with SCA in models adjusted for age, sex, and other clinical variables: chronic kidney disease (odds ratio [OR], 7.3 [95% CI, 3.8-14.3]), heavy drinking (OR, 4.5 [95% CI, 2.3-9.0]), stroke (OR, 3.1 [95% CI, 1.2-8.0]), atrial fibrillation (OR, 3.7 [95% CI, 1.7-7.9]), coronary artery disease (OR, 2.9 [95% CI, 1.5-5.9]), heart failure (OR, 2.5 [95% CI, 1.2-5.1]), and diabetes (OR, 1.5 [95% CI, 1.0-2.3]). Conclusions In this first population-based study, to our knowledge, of SCA risk predictors among Hispanic or Latino adults, chronic kidney disease was the strongest risk factor for SCA, and established cardiovascular disease was also important. Early identification and management of chronic kidney disease may reduce SCA risk among Hispanic or Latino individuals, in addition to prevention and treatment of cardiovascular disease.

PO-03-222 CURRENT TRENDS AND OUTCOMES OF SUDDEN CARDIAC ARREST IN YOUNG ADULTS IN THE USA: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE

Sudden cardiac arrest (SCA) is a rare but devastating event in young adults. There is a lack of population studies that evaluate the current trends and outcomes of SCA in young adults. We sought to estimate current trends in incidence, risk factors and mortality rates for out-of-hospital SCA in young adults (18 – 35 years) using the national in-patient sample of the USA. The demographic data of all young adults (18 – 35 years) admitted to hospitals in the US from 2016 to 2020 was analysed using the National Inpatient Sample database. We further identified primary admissions for sudden cardiac arrest using the ICD 10 code (I46). We analyzed the trend in the incidence and mortality of SCA during the study period using the marginal effect of years. Subsequently, we compared the sociodemographic and comorbid factors of patients with out-of-hospital SCA with other young adults admitted to the hospital. Multivariate logistic regression was then used to determine the sociodemographic and comorbid factors independently associated with SCA in our population. There were approximately 3,610 cases of out of hospital cardiac arrest in the study period, with an incidence rate of 1:10000 young adult admissions. The mean age at admission was (28.3 ± 0.4 years). We noted a 16.7% increase in SCA cases from 2016 to 2020 (660 to 770 cases). Similarly, there was a 21% increase in the mortality between 2016 and 2020 (474 to 574 deaths), with a mean mortality rate of 69.7% throughout the study period. The main factors associated with increased odds of SCA in young people were the presence of arrhythmias. Other significant risk factors were male sex, a history of stroke, electrolyte abnormalities, renal failure on hemodialysis, hypertrophic cardiomyopathy, congenital heart disease, and cocaine use disorder. There is an increase in the incidence of sudden cardiac arrest in young adults, with the main risk factors being male sex, history of stroke, hypertrophic cardiomyopathy, congenital heart disease, presence of arrhythmias and cocaine use disorder. Identifying young adults with high-risk characteristics as described above and implementing risk factor modification with aggressive surveillance can reduce the incidence of SCA and the risk of death in young adults.Tabled 1Sociodemographic and comorbid factors associated with Sudden Cardiac Arrest in Young AdultsVARIABLESOdds ratioLower limit of CIUpper limit of CIP-valueAGE1.000.981.020.373RACE (Reference, Whites)BlacksHispanicsAsians-1.070.621.25-0.850.450.78-1.360.842.01-0.5530.002*0.628Female0.410.330.51<0.001*Smoking0.760.571.030.077Dyslipidemia0.430.240.770.004*History of myocardial infarction0.730.182.960.663COPD1.270.572.840.558Stroke5.462.999.97<0.001*Hypertension0.750.561.010.057Hypothyroidism1.330.842.080.225Obesity0.920.691.240.593Arrhythmia27.5221.435.3<0.001*Electrolyte Derangement13.410.517.1<0.001*ESRD on Hemodialysis2.401.463.940.001*Oxygen Dependence1.170.363.790.792Hypertrophic cardiomyopathy7.893.0420.45<0.001*Cocaine Use Disorder1.761.202.570.004*Congenital heart disease2.941.725.03<0.001*∗Statistically significant findings, COPD - chronic obstructive pulmonary disease, CI - Confidence interval Open table in a new tab

A descriptive analysis of cross-sectional imaging findings in patients after non-traumatic sudden cardiac arrest

IntroductionCross-sectional imaging is frequently obtained after sudden cardiac arrest (SCA) to determine the aetiology. Although imaging studies may reveal acute and/or chronic findings that may impact downstream medical management, lack of standardized guidelines results in significant practice variability. We aimed to perform a descriptive analysis and to report on radiographic findings after SCA. MethodsThis was a retrospective observational descriptive study that included all adult SCA patients who presented to our emergency department (ED) over a 6-year period, achieved sustained return of spontaneous circulation, and subsequently received cross-sectional imaging while in the ED. Each imaging study was reviewed and graded based on a predefined scale, and significant radiographic findings were tabulated. Results1573 patients were identified, and 452 patients remained after applying predefined exclusion criteria. A total of 298, 184, and 113 computed tomography (CT) studies were performed of the head, chest, and abdomen, respectively. For head, chest, and abdominal imaging, 13 (4.4%), 23 (12.5%), and 6 (5.3%) studies had radiographic findings that likely contributed to SCA, respectively. Altogether, 42 (7.1%) radiographic studies had findings that likely contributed to SCA. Eighty (13.4%) studies (head [n = 38, 12.8%], chest [n = 26, 14.1%], abdomen [n = 16, 14.2%]) resulted in a change of clinical care (e.g. specialty consultation or procedures). ConclusionGiven the clinical uncertainty and relative instability during the post-SCA phase, cross-sectional imaging frequently reveals important acute and chronic diagnostic findings.

Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest

AimCoronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA. MethodsFrom May 2011 to May 2017, all cases of out-of-hospital SCA aged 18–40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed. ResultsOut of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25–0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21–6.00). ConclusionCAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.

Abstract 148: Installation and Deployment of Automated External Defibrillators in New York State Schools

Introduction: AHA recommends that automated external defibrillators (AEDs) be made available in public areas with high likelihood of a sudden cardiac arrest (SCA). Only 18 US states have regulations requiring AEDs in schools and the legislation varies. There is no comprehensive evaluation of the epidemiology of sudden death in schools. School nurses are often the only healthcare providers within a school. New York State (NYS) enrolls almost 3.5 million students with New York City (NYC) being the largest school system in the US; legislation requires AEDs in all public but not in private schools. Purpose: Our aims were threefold: to gain epidemiologic data on SCAs in NYS schools, to evaluate the availability and utilization of AEDs, and to identify factors affecting deployment of AEDs. Methods: Electronic surveys were sent to school nurse members of the NYS Association of School Nurses and NYC school nurses. We also conducted structured interviews with a representative sample of NYS school nurses. Results: Nurses representing 750 public schools and 116 private schools responded, a response rate of 36.4%. There were 71 SCA events, with majority affecting adults on school grounds 41 (58%). AEDs were deployed in 59 (73%). Short term survival occurred in 50 (69%) with 40 (56%) returning to regular activity. While not required to have AEDs available, most private schools had them 69(60%). There were 21 (30%) SCA events in private schools with 8 (11%) occurring in private schools with no AEDs. Of these, 6 (75%) had a negative outcome. Interviews revealed that staff attitude, fear, and training adequacy were factors influencing AED utilization. Conclusions: AEDs in schools improve survival outcomes. There has been no comprehensive evaluation of SCA events in US schools and no uniformity in AED legislation among states. While focus is on students, NYS data suggests that attention should also encompass adult SCAs in schools. Comparisons of AED utilization and SCA outcomes in states with and without AED legislation will be of interest, and may have health policy implications.

Prevalence and Outcomes of Sudden Cardiac Arrest in a University Hospital in the Western Region, Saudi Arabia.

Background:Sudden cardiac arrest (SCA) is a major cause of mortality, yet its epidemiological and outcome data in hospitals from Saudi Arabia are limited.Objectives:This study aimed to evaluate the prevalence, risk factors and outcomes of SCA in a teaching hospital in Jeddah, Saudi Arabia.Methods:This retrospective study included all patients aged ≥18 years with SCA who were resuscitated at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 1 and December 31, 2016. Data were retrieved from the hospital medical records as flow sheets designed in accordance with the Utstein-style recommendations. Factors relating to mortality were analyzed using descriptive analyses and chi-square test.Results:A total of 429 cases of SCA met the inclusion criteria, and its prevalence was 7.76 cases/1000 adult hospital admission. Of these, 61.3% were male, and the mean age was 58.4 years, with 36.6% aged >65 years. Only 3.5% were outside-hospital cardiac arrests. The most common initial rhythm was pulseless electrical activity/asystole (93.2%), while ventricular tachycardia/ventricular fibrillation was documented in only 29 cases (6.8%). The overall rate of return to spontaneous circulation (ROSC) was 56.2%, and 56.8% in cases of in-hospital cardiac arrest (IHCA). Patients with SCA due to sepsis had significantly increased mortality (P < 0.000; odds ratio [OR] = 0.24 [0.12–0.47 95% confidence interval [CI]]), while those with SCA due to respiratory causes had significantly better survival outcomes (P = 0.001; OR = 2.3 [1.5–3.8 95% CI]). No significant differences in outcomes were found between other risk factors, including cardiac causes.Conclusion:In this population, the prevalence of SCA in adults was higher than reported in many similar studies. Further, sepsis was found to affect the survival rate. Although the rate of ROSC for IHCA patients was favorable compared with other studies, it is relatively poor. This finding signifies the need to identify and control risk factors for SCA to improve survival.

Sudden cardiac arrest related to coronary artery disease in young adults

Considering major shifts in coronary artery disease (CAD) epidemiology over the last two decades, we hypothesized that CAD was probably henceforth the main etiology of sudden cardiac arrest (SCA) among young adults. To describe burden and features of CAD-related SCA in young (≤ 40 year-old) adults using a contemporary community-based study. From May 2011 to 2016, all cases of SCA admitted alive across 48 hospitals of the Greater Paris Area were prospectively enrolled and young SCA (< 40 years) specifically assessed. Cardiovascular causes of SCA were determined from medical reports with central adjudication. Out of 18,662 out-of-hospital cardiac arrests, 3028 SCA were admitted alive, with 353 (11.7%) being ≤ 40 year-old (32.1 ± 6.2 year-old, 70.8% males). Among the 1,557 (51.4%) patients with an established cardiac cause, 142 (9.1%) were aged less than 40-years. CAD accounted for 58 (40.8%) cases, whereas non-ischemic heart disease and non-structural heart disease for 52 (36.6%) and 32 (22.5%), respectively. Within the 30–40 year age group, CAD represented 53.7% of all diagnoses. While 86.2% of CAD-related young SCA was due to an acute coronary syndrome (ACS), rate of immediate coronary angiography at hospital admission was only 39.2% compared to 63.4% among those > 40-years (OR = 0.38, 95% CI: 0.27–0.53, P < 0.001), and remained associated with survival at hospital discharge (OR = 4.18, 95% CI: 1.98–9.14, P < 0.001) ( Fig. 1 ). CAD is a major cause of SCA in young adults, representing > 50% of SCAs occurring in the fourth decade. With ACS representing the major part of these events, the observed low rates of immediate coronary angiography suggest an important missed opportunity for early intervention.

The influence of emergency medical procedures and event circumstances on the acute effectiveness of resuscitation in out-of-hospital sudden cardiac arrest in adults

The influence of emergency medical procedures and event circumstances on the acute effectiveness of resuscitation in out-of-hospital sudden cardiac arrest in adults

P058: Morbid obesity association with return of spontaneous circulation from sudden cardiac arrest treated in a large, urban EMS system in the United States

Introduction: Patient co-morbidities contribute to survivability from out-of-hospital sudden cardiac arrest. Many studies have been conducted regarding contributing factors to sudden cardiac arrest survival, though very few studies have been published detailing specific analysis of morbid obesity association with return of spontaneous circulation (ROSC) in adults treated by paramedics. Methods: Adults in sudden cardiac arrest with resuscitation initiated, including at least one defibrillation, between July 1, 2016 and December 1, 2016 were enrolled. Due to an increasing prevalence of morbid obesity in the United States adult population, a novel defibrillation strategy, involving weight-based joule settings and double sequential external defibrillation (DSED) was initiated in June 2016. As exact body weight is logistically difficult to obtain in the EMS care environment, a paramedic-estimated weight at the time of resuscitation to be 100 kg or greater was deemed representative of “morbid obesity” for this analysis. All resuscitations were reviewed from electronic medical records (EMRs) completed by treating paramedics, alongside telemetry and defibrillation events recorded, transmitted, and analyzed in proprietary software (CODE-STAT, Physio-Control Corporation, Redmond, WA). ROSC was determined from both paramedic and hospital clinician EMRs reviewed by a paramedic researcher. Results: During the 5 month study period, paramedics involved treated 133 adults in sudden cardiac arrest involving perceived ventricular fibrillation that was treated with at least one defibrillation. 49/90 (54.4%) with weight &amp;lt;100 kg as estimated by paramedics at the time of resuscitative care achieved at least transient ROSC. Only 17/43 (39.5%) with estimated weight ≥100 kg achieved any ROSC, despite paramedics authorized to perform defibrillations at higher joule energy settings for such weight. The OR for ROSC if &amp;lt;100 kg estimated weight is 1.83 (95% CI 0.87-3.83), though given limited sample size p=0.11. Conclusion: While survival from out-of-hospital sudden cardiac arrest in adults is multi-factorial, the presence of morbid obesity, defined as estimated weight ≥100 kg, trends towards less ROSC. Continued community health efforts to decrease the prevalence of morbid obesity in the adult population may confer improved ability to survive out-of-hospital sudden cardiac arrest.

Wide QRS‐T Angle on the 12‐Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction

Improvements in risk stratification for sudden cardiac arrest (SCA) will require discovery of markers that extend beyond the LV ejection fraction (LVEF). The frontal QRS-T angle has been shown to predict risk of SCA but the value of this marker independent of the LVEF has not been investigated. Cases of adult SCA with an archived electrocardiogram (12-lead ECG) available before the event, with a computable frontal QRS-T angle, were identified from the Oregon Sudden Unexpected Death Study (Oregon SUDS) ongoing in the Portland, Oregon metro area. A total of 666 SCA cases (mean age 67.2 years; 95% CI, 52.3-82.1 years; 68.6% males) were compared to 863 controls (mean age 66.6 years, 55.2-78.0 years; 68.1% males; 75.0% had CAD) from the same geographical region. The mean frontal QRS-T angle was wider in cases (74(o) ; 95% CI, 17(o) -131(o) ) compared to controls (51(o) ; 95% CI, 5(o) -97(o;) P< 0.0001). A frontal QRS-T angle of more than 90(o) remained associated with increased risk of SCD after adjusting for age, gender, heart rate, prolonged intraventricular conduction, electrocardiographic left ventricular hypertrophy (ECG LVH), baseline comorbidities, and left ventricular ejection fraction (LVEF) (OR 2.2; 95% CI, 1.60-3.09; P< 0.0001). A wide QRS-T angle greater than 90(o) is associated with an increased risk of SCA independent of the left ventricular ejection fraction.

Comparison of Bio-signal Characteristics between Ventricular Fibrillation Observed in Clinical Experiments and Ventricular Fibrillation in Animal Models

Ventricular fibrillation is one of the most common causes of sudden cardiac arrest in adults. A lot of research has been done on ventricular fibrillation. However, that research draws conclusions from animal studies and they could not induce artificial ventricular fibrillation in human subjects. This paper looks at whether there is a difference between ventricular fibrillations in animal models and in human models, with comparisons of ventricular fibrillation obtained from the two groups. This study compares and analyzes electrocardiography (ECG) wave forms as electrical bio-signals of the two groups, in which the histogram of gradient (HOG) and auto-associative multilayer perceptrons (AAMLP) are applied for feature extraction and pattern analysis, repsectively, of the biosignals. The characteristics of electrical signals in animal ventricular fibrillation and those in human ventricular fibrillation are conclusively similar and it is reasonable to adapt the results obtained from animal research to clinical practices.

Determinants of unfavorable prognosis for out-of-hospital sudden cardiac arrest in Bielsko-Biala district.

IntroductionThe prognosis in out-of-hospital sudden cardiac arrest (OHCA) remains unfavorable and depends on a number of demographic and clinical variables, the reversibility of its causes and its mechanisms.AimTo investigate the risk factors of prehospital death in patients with OHCA in Bielsko County.Material and methodsThe study analyzed all dispatch cards of the National Emergency Medical Services (EMS) teams in Bielsko-Biala for the year 2013 (n = 23 400). Only the cards related to sudden cardiac arrest in adults were ultimately included in the study (n = 272; 190 men, 82 women; median age: 71 years).ResultsSixty-seven victims (45 men, 22 women) were pronounced dead upon the arrival of the EMS team, and cardiopulmonary resuscitation (CPR) was not undertaken. In the remaining group of 205 subjects, CPR was commenced but was ineffective in 141 patients (97 male, 44 female). Although univariate analysis indicated 6 predictors of prehospital death, including OHCA without the presence of witnesses (odds ratio (OR) = 4.2), OHCA occurring in a public place (OR = 3.1), no bystander CPR (OR = 9.7), no bystander cardiac massage (OR = 13.1), initial diagnosis of non-shockable cardiac rhythm (OR = 7.0), and the amount of drugs used for CPR (OR = 0.4), logistic regression confirmed that only the lack of bystander cardiac massage (OR = 6.5) and non-shockable rhythm (OR = 4.6) were independent determinants of prehospital death (area under ROC curve = 0.801).ConclusionsNon-shockable rhythm of cardiac arrest and lack of bystander cardiac massage are independent determinants of prehospital death in Bielsko-Biala inhabitants suffering from OHCA.

Abstract 15714: Electrical versus Anatomic Left Ventricular Hypertrophy Associated With Sudden Death

Introduction: We have previously reported that electrocardiographic (ECG) left ventricular hypertrophy (LVH) can occur in the absence of increased LV mass (echocardiographic LVH), and conveys unique risk of sudden cardiac arrest (SCA). We further characterized this adverse “electrical remodeling” by comparing SCA cases with isolated electrical vs. isolated anatomic LVH. Hypothesis: Cases with electrical versus anatomic LVH have distinct clinical profiles Methods: Adult SCA cases were prospectively ascertained from multiple sources in a Northwestern US metro area (population approx. 1 million). Clinical/demographic information was obtained from medical records. ECGs, prior and unrelated to SCA were reviewed in blinded fashion to detect ECG-LVH (Sokolow-Lyon criteria). LV mass, obtained from echocardiograms was used to identify echo-LVH (LV Mass Index &gt; 134 g/m2 men; 110 g/m2 women). Cases with isolated ECG-LVH versus isolated echo-LVH were compared to identify distinctive characteristics. Patients who had LVH by both tests and those without LVH by either test were excluded. Results: Among 323 SCA cases (2002-14; 69.0 ± 13.5 yrs; 66.9% male) with adequate information available, echo-LVH was present in 134 (41.5%) cases and ECG-LVH in 58 (18.0%) cases. After elimination of cases with LVH by both modalities, 103 (31.9%) cases had isolated echo-LVH while 27 (8.3%) had isolated ECG-LVH. Compared to cases with isolated ECG-LVH, isolated echo-LVH cases had lower LV ejection fraction (45.2 ± 16.9 vs. 53.0 ± 14.8%; p=0.03), were more likely to be current smokers (30.8 vs. 8.7%; p=0.06), obese (41.7 vs. 25.9%; p=0.12) and African-American (19.4 vs 7.4%; p=0.15). There were no significant differences between the two groups for systemic hypertension (78.6 vs. 88.9%; p=0.23), age, sex, diabetes, renal disease, coronary artery disease or prior myocardial infarction. Prescription of anti-hypertensive medications including ACE inhibitors, angiotensin receptor blockers and beta blockers were equally likely in both groups. Conclusions: Patients with electrical vs. anatomic LVH appear to have distinct clinical profiles. These findings can serve as a foundation for further investigation of genetic and acquired mechanisms of electrical LVH leading to sudden death.

Abstract 16416: Wide QRS-T Angle on the 12-lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction

Introduction: If we are to improve risk stratification for sudden cardiac death (SCD) we should extend beyond the LV ejection fraction (LVEF). The frontal QRS-T angle has been shown to predict risk of SCD but its value independent of LVEF has not been investigated. Hypothesis: We hypothesize that a wide frontal QRS-T angle predicts SCD independent of LVEF. Methods: Cases of adult sudden cardiac arrest with an available electrocardiogram before the event were identified from a large ongoing population based study of SCD in the Northwest US (population approx. one million). Subjects with a computable frontal QRS-T angle were included. A total of 686 SCD cases (mean age 67.4 years; 95% CI, 52.5 to 82.3 years; 68.2% males; 83.5% whites) met criteria, and were compared to 871 controls with and without coronary artery disease (mean age 66.8 years, 55.3 to 78.3 years; 67.7% males; 90.6% whites) from the same geographical region. Results: The mean frontal QRS-T angle was higher in SCD cases (73.9 degrees; 95% CI, 17.5 to 130.3 degrees, p&lt;0.0001) compared to controls (51.1 degrees; 95% CI 5.0 to 97.2 degrees). Using a cut-off of more than 90 degrees, the frontal QRS-T angle was predictive of SCD, and remained predictive, after adjusting for age, sex, left ventricular ejection fraction (LVEF), prolonged QTc, prolonged QRS duration and baseline comorbidities (OR 1.80; 95% CI, 1.27 to 2.55, p=0.001). On the receiver operating characteristic (ROC) curve, the QRS-T angle demonstrated an area-under-curve (AUC) value of 0.614. Compared to the lowest quartile of QRS-T angle, the highest quartile had nearly a triple increase in the risk of SCD (OR 2.71; 95% CI; 2.03 to 3.60; p&lt;0.0001). Conclusion: A wide QRS-T angle greater than 90 degrees is associated with increased risk of sudden cardiac death independent of left ventricular ejection fraction.

Sudden Cardiac Arrests, Automated External Defibrillators, and Medical Emergency Response Plans in Tennessee High Schools

Schools are important public locations of sudden cardiac arrest (SCA), and the American Heart Association (AHA) recommends medical emergency response plans (MERPs), which may include an automated external defibrillator (AED) in schools. The objective of this study was to determine the incidence of SCA and the prevalence of AEDs and MERPs in Tennessee high schools. Tennessee Secondary School Athletic Association member schools were surveyed regarding SCA on campus within 5 years, AED presence, and MERP characteristics. Of 378 schools, 257 (68%) completed the survey. There were 21 (5 student and 16 adult) SCAs on school grounds, yielding a 5-year incidence of 1 SCA per 12 high schools. An AED was present at 11 of 21 schools with SCA, and 6 SCA victims were treated with an AED shock. A linear increase in SCA frequency was noted with increasing school size (<500 students: 3.3% incidence, 500-1000: 6.5%, 1000-1500: 12.5%, ≥1500: 18.2%; P = 0.003). Of 257 schools, 71% had an MERP, 48% had an AED, and only 4% were fully compliant with AHA recommendations. Schools with a history of SCA were more likely to be compliant (19% vs. 3%, P = 0.011). The 5-year incidence of SCA in Tennessee high schools is 1 in 12, but increases to 1 in 7 for schools with more than 1000 students. Compliance with AHA guidelines for MERPs is poor, but improved in schools with recent SCA. Future recommendations should encourage the inclusion of AED placement in schools with more than 1000 students.

Incidence and Predictors of Sudden Cardiac Arrest in Adults With Congenital Heart Defects Repaired Before Adult Life

Many adult survivors of repaired congenital heart disease (CHD) are at premature risk of death. Sudden cardiac arrest (SCA) is 1 of the leading causes of death but little is known about determinants for SCA in adults with repaired lesions. We sought to determine incidence and risk factors for SCA in a study population of 936 adults with previously repaired CHD who had completed follow-up at a single tertiary center during a mean period of 9 ± 7 years. Mean age at first examination in our institution was 21 ± 7 years. Diagnostic categories included tetralogy of Fallot (216), coarctation of the aorta (157), transposition complexes (99), single ventricle (55), and other CHD (409). During a total follow-up of 8,387 person-years, 22 patients (2.6 per 1,000 person-years) presented with SCA. Incidence of SCA varied widely between specific lesions; the highest incidence was observed in transposition complexes (10 per 1,000 person-years). Independent predictors of SCA were retrospectively identified using multivariate Cox proportional hazard modeling. Age at initial examination and severely impaired subaortic ventricular systolic function were independent risk factors for SCA (severe subaortic ventricular systolic dysfunction, adjusted hazard ratio 29, 95% confidence interval 11 to 72, p <0.001). SCA occurred in 23% of patients with severe subaortic ventricular systolic dysfunction versus 0.7% of patients with nonsevere decreased subaortic ventricular function (p <0.001). In conclusion, severe subaortic ventricular systolic dysfunction is a dominant multivariate predictor of SCA in an unselected population of adult survivors after surgery for CHD. Our data support the consideration of primary prevention strategies in these patients.

Women Have a Lower Prevalence of Structural Heart Disease as a Precursor to Sudden Cardiac Arrest: The Ore-SUDS (Oregon Sudden Unexpected Death Study)

Our aim was to utilize a community-based approach to identify sex-related differences in risk factors for sudden cardiac arrest (SCA). There are significant sex-based differences in prevalence and manifestation of SCA. Any differences related to predictors of SCA in women versus men are likely to have implications for risk stratification and prevention. The Ore-SUDS (Oregon Sudden Unexpected Death Study) is an ongoing prospective investigation of SCA in the Portland, Oregon, metropolitan area (population approximately 1 million). All cases meeting criteria for SCA were ascertained using multiple sources. Medical records were reviewed to identify clinical conditions that may contribute to SCA risk, and comparisons were made between male and female SCA cases using Pearson's chi-square tests for categorical variables, t tests for continuous variables, and multivariate logistic regression analysis. During 2002 to 2007, 1,568 adult SCA cases were identified (women 36% vs. men 64%; p < 0.0001) and women were older (mean age 71 +/- 14 years vs. 65 +/- 14 years, p < 0.0001). There were no significant sex differences in prevalence of obesity, dyslipidemia, history of chronic obstructive pulmonary disease/asthma, left ventricular (LV) hypertrophy, or history of myocardial infarction. In multivariate analysis, women were significantly less likely to have severe LV dysfunction (odds ratio: 0.51; 95% confidence interval: 0.31 to 0.84) or previously recognized coronary artery disease (odds ratio: 0.34; 95% confidence interval: 0.20 to 0.60) compared with men. Women were significantly less likely than men to have a diagnosis of structural heart disease (LV dysfunction or coronary artery disease) before SCA. These findings suggest that fewer women may be eligible for prophylactic implantable cardioverter-defibrillator placement based on current guidelines and therefore may not have equal opportunity for prevention. Enhancement of SCA risk stratification may have even higher importance for women.

Cardiopulmonary resuscitation – automated external defibrillation programs for children and adolescents: Is public access defibrillation directed at our youth justifiable?

Cardiopulmonary resuscitation – automated external defibrillation programs for children and adolescents: Is public access defibrillation directed at our youth justifiable?

Energy attenuator for pediatric application of an automated external defibrillator.

Although automatic external defibrillators (AEDs) are extensively deployed to rapidly treat sudden cardiac arrest in adults, their applicability for children is presently limited. It is desirable to extend the indications for this lifesaving equipment to all ages, even though AED application to children will be rare compared with adults. It is imperative that the inherent simplicity of present adult AED operation not be compromised to extend its use to include children. We propose a method that does not affect the normal operation of an AED on adults. For adults, unmodified AEDs would be used normally with adult electrodes. However, special pediatric electrodes would be available as a disposable accessory. When used with the AED, the delivered energy would be reduced within the electrodes, and only a portion of the energy output by the AED would be delivered to the pediatric patient. These electrodes could be used in conjunction with currently deployed AEDs with electrocardiographic analysis algorithms appropriate for children. This eliminates the need for a separate AED specifically for children or the purchase of a new AED with pediatric capability to replace previously deployed models.