Sudden cardiac arrest: ECG repolarization after resuscitation.
BACKGROUND
Early repolarization (ERep) abnormalities on electrocardiogram (ECG) are common immediately following cardiac arrest. We characterized and correlated electrocardiographic repolarization abnormalities immediately after cardiac arrest with acute coronary angiography.


RESULTS
We studied 225 consecutive patients presenting with out-of-hospital cardiac arrest. All these patients had successful cardiopulmonary resuscitation and acute coronary angiography. The first ECG recorded after successful resuscitation was analyzed by two independent cardiologists. Patients were categorized according to their repolarization pattern. Pattern 1: No ST segment elevation or ERep. Pattern 2: ST segment elevation without ERep. Pattern 3: ST segment elevation and ERep. Pattern 4: ERep only. Patterns 1, 2, 3, and 4 were found in 112 (50%), 74 (33%), 19 (8%), and 20 (9%) patients, respectively. Cardiac arrest was due to acute myocardial ischemia in 45%, 82%, 39%, and 15% of patients in groups 1, 2, 3 and 4, respectively (P < 0.0001). Sensitivity and specificity of pattern 2 was 50% and 88%, respectively, for acute coronary lesion, whereas isolated ERep pattern occurred in 9% of cases and was associated with a nonischemic event (80%). Among 65 patients (29%) who survived, 7% of patients with pattern 1, 13% with pattern 2, 60% with pattern 3, and 88% with pattern 4 exhibited ERep on ECG during the follow-up.


CONCLUSIONS
In the context of cardiac resuscitation, an ECG with ST elevation favors acute myocardial infarction, whereas the presence of ERep is a marker of a nonischemic event and future ERep syndrome.
Lellouche
Nicolas
N
Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris et INSERM U 841, Creteil, France. nicolellouche@yahoo.com
Sacher
Frederic
F
Jorrot
Pierre
P
Cariou
Alain
A
Spaulding
Christian
C
Aurore
Amandine
A
Combes
Xavier
X
Fichet
Jerome
J
Teiger
Emmanuel
E
Jais
Pierre
P
Dubois-Randé
Jean-Luc
JL
Haissaguerre
Michel
M
D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012151:Resuscitation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors