title: Causes and prognosis of cardiac arrest in a population admitted to a general hospital; a diagnostic and therapeutic problem.
abstract: BACKGROUND
  The purpose of this study was to determine the causes and the prognosis of consecutive patients resuscitated from cardiac arrest occurring in a general hospital. We assessed 28 females and 94 males (aged 13-82 years) who were resuscitated from cardiac arrest not attributable to acute myocardial infarction. Ventricular fibrillation (VF) was documented in 97. Non-cardiac causes were excluded. Non-invasive studies (24 h Holter monitoring, 2D echocardiogram, signal-averaged ECG, exercise testing, magnetic resonance imaging) and invasive studies (right and left ventricular angiography, coronary angiography and complete electrophysiologic study (EPS) were performed.
  
  
  RESULTS
  An underlying cardiac disease was found in 107 patients (88%). Patients were followed for a period ranging from 6 months to 10 years (mean 4+/-5 years). Several causes for cardiac arrest were identified and treated specifically. The prognosis was variable. Among surviving patients the following causes of cardiac arrest were found: Wolff-Parkinson-White syndrome (n=2), rapid supraventricular tachycardia (n=6), acquired or congenital long QT syndrome (n=7), complete atrioventricular block (n=3), proarrhythmic effect of an antiarrhythmic drug (n=5), vasospastic angina (normal coronary arteries) (n=5). Among ten patients with VF related to cardiac ischaemia two died suddenly. Ventricular tachycardia (VT) or VF was the main cause leading to resuscitation after cardiac arrest (n=64). The risk of recurrence of arrest is confirmed in the present study particularly in patients in whom VT/VF could not be suppressed by antiarrhythmic drug therapy (n=45) and in those where an ICD was not implanted (18 cardiac deaths (nine sudden cardiac deaths (SCD's)). The cause of cardiac arrest was not elucidated in 20 patients (16%). The prognosis of these patients differed according to the documentation of VF at the time of cardiac arrest: of those with documented VF (n=12), six patients died suddenly (one with an ICD); of those without documented VF (n=8), all are alive.
  
  
  CONCLUSIONS
  To determine the precise cause of cardiac arrest was the first problem; the diagnosis of cardiac arrest clearly was erroneous in 8 of 122 patients (6.5%). In other patients, a ventricular tachyarrhythmia was identified as the cause for cardiac arrest in half of the population; the indication for an ICD is evident in this group. In 31% of patients with proven cardiac arrest, another arrhythmia requiring specific treatment was identified and ICD implantation was avoided; these patients had a survival of 92% at 3 years. In patients without an identified cause of cardiac arrest and negative EPS, the prognosis was unfavorable only in those with documented VF.
authors.affiliation: Cardiology A, CHU of Brabois, F54500 Vandoeuvre Rue du Morvan, F54500 Vandoeuvre les Nancy, France. b.brembilla-perrot@chu-nancy.fr
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.forename: Hielko
authors.initials: H
authors.lastname: Miljoen
authors.forename: Pierre
authors.initials: P
authors.lastname: Houriez
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.forename: Marc
authors.initials: M
authors.lastname: Nippert
authors.forename: Anne Claire
authors.initials: AC
authors.lastname: Vançon
authors.forename: Arnaud Terrier
authors.initials: AT
authors.lastname: de la Chaise
authors.forename: Pierre
authors.initials: P
authors.lastname: Louis
authors.forename: Laurent
authors.initials: L
authors.lastname: Mock
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation; D017147:Defibrillators, Implantable; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis