Nonventricular arrhythmias as precursors of ventricular fibrillation in patients with out-of-hospital cardiac arrest.
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the most common arrhythmias documented at the time of resuscitation in survivors of out-of-hospital cardiac arrest unassociated with an acute myocardial infarction. However, 20% and 40% of these patients will not manifest inducible ventricular arrhythmias during subsequent electrophysiologic studies. The optimal management of these patients has been controversial. In a consecutive series of 100 survivors of out-of-hospital cardiac arrest with documented VF, six were identified by either clinical or electrophysiologic data as having a nonventricular arrhythmia as the immediate precursor of VF. Two of these patients had rapid, hypotensive supraventricular arrhythmias induced with programmed cardiac stimulation. In four patients, bradyarrhythmias (sinus arrest two; atrioventricular block two) preceded and caused the episode of VF. Therapy directed at these nonventricular arrhythmias prevented recurrence of cardiac arrest in all patients. In survivors of out-of-hospital cardiac arrest, nonventricular arrhythmias represent a treatable potential etiology that may be overlooked during the patient's evaluation.
Hays
L J
LJ
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Lerman
B B
BB
DiMarco
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D014693:Ventricular Fibrillation / Q000209:etiology*