title: Sudden cardiac arrest recorded during Holter monitoring: prevalence, antecedent electrical events, and outcomes.
abstract: BACKGROUND
  Causative arrhythmias of sudden cardiac arrest (SCA) are changing in this age of improved coronary care.
  
  
  OBJECTIVE
  The purpose of this study was to examine the frequency of terminal arrhythmias and the electrical events prior to SCA.
  
  
  METHODS
  We analyzed 24-hour Holter recordings of 132 patients enrolled from 41 institutions who either died (n = 88) or had an aborted death (n = 44). The Holter recordings were obtained for diagnosing and evaluating diseases and arrhythmias in those without any episodes suggestive of SCA.
  
  
  RESULTS
  In 97 patients (73%), SCA was associated with ventricular tachyarrhythmias and in 35 (27%) with bradyarrhythmias. The bradyarrhythmia-related SCA patients were older than those with a tachyarrhythmia-related SCA (70 ± 13 years vs. 58 ± 19 years, P < .001). The most common arrhythmia for a tachyarrhythmia-related SCA was ventricular tachycardia degenerating to ventricular fibrillation (45%). The bradyarrhythmia-related SCA was caused by asystole (74%) or AV block (26%). Spontaneous conversion was observed in 37 patients (38%) with ventricular tachyarrhythmias. Of those, 62% of the patients experienced symptoms including syncope, chest pain, or convulsion. Multivariate logistic analysis revealed that independent predictors of mortality for tachyarrhythmia-related SCAs were advanced age (odds ratio 1.04, 95% confidence interval 1.02-1.08) and ST elevation within the hour before SCA (odds ratio 3.54, 95% confidence interval 1.07-13.5). In contrast, the presence of preceding torsades de pointes was associated with spontaneous conversion (odds ratio 0.20, 95% confidence interval 0.05-0.66).
  
  
  CONCLUSIONS
  The most frequent cause of SCA remains ventricular tachyarrhythmias. Advanced age and ST elevation before SCA are risk factors for mortality in tachyarrhythmia-related SCAs.
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: enwatan@fujita-hu.ac.jp.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Tanabe
authors.affiliation: Department of Basic Science, Nippon Veterinary and Life Science University, Tokyo, Japan.
authors.forename: Motohisa
authors.initials: M
authors.lastname: Osaka
authors.affiliation: Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Chishaki
authors.affiliation: Department of Intensive Care Unit, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Bonpei
authors.initials: B
authors.lastname: Takase
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Niwano
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
authors.affiliation: International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Katoh
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Takayanagi
authors.affiliation: Department of Cardiology, Kagoshima Seikyo Hospital, Kagoshima, Japan.
authors.forename: Koushi
authors.initials: K
authors.lastname: Mawatari
authors.affiliation: Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Cardiology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.affiliation: Tsukuba University School of Medicine, Tsukuba, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Yamaguchi
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Nagasawa
authors.affiliation: Fukuoka University School of Medicine, Fukuoka, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Moroe
authors.affiliation: Nagoya University, Nagoya, Japan.
authors.forename: Itsuo
authors.initials: I
authors.lastname: Kodama
authors.affiliation: Kanto Central Hospital, Tokyo, Japan.
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Division of Research and Development, Tachikawa Medical Center, Nagaoka, Japan.
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014693:Ventricular Fibrillation / Q000401:mortality / Q000503:physiopathology*; D055815:Young Adult
keywords: Arrhythmia; Electrocardiogram; Holter recording; Sudden death; Survivor