Investigation following resuscitated cardiac arrest.
Roughly two thirds of resuscitated cardiac arrests in children and youth are due to inherited heart diseases. The most commonly implicated are the cardiac ion channelopathies long QT syndrome, CPVT (catecholaminergic polymorphic ventricular tachycardia) and Brugada syndrome. Diagnosis is pivotal to further management of the child if he/she survives, and also to other family members who may be at risk. Thorough investigation of the cardiac arrest survivor is essential to either identify or exclude inherited heart disease. If standard cardiac investigation does not reveal a diagnosis, pharmacological provocation tests are needed to unmask electrocardiographic signs of disease, even if, due to severe brain injury, it is planned ultimately to allow a natural death. Examples are the ajmaline/flecainide challenge for Brugada syndrome and epinephrine for CPVT. A supportive, informative and sympathetic approach to the family is essential. An arrhythmia specialist and a cardiac genetic service should be involved early, with storage of DNA and cardiac/genetic investigation of the family. This review proposes a diagnostic algorithm-based approach to the investigation of this increasingly common clinical scenario.
Greenlane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Grafton, Auckland, New Zealand. jskinner@adhb.govt.nz
Jonathan R
JR
Skinner
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy*; D006331:Heart Diseases / Q000235:genetics*; D006801:Humans; D055815:Young Adult