Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study

• Published in: Journal of the American College of Cardiology Vol. 4; no. 1; pp. 39 - 44
• Main Authors: Morady, Fred, DiCarlo, Lorenzo, Winston, Stuart, Davis, Jesse C., Scheinman, Melvin M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-1984; Elsevier Science
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Catheterization; Cardiac Pacing, Artificial; Coronary Disease - complications; Coronary Disease - drug therapy; Coronary Disease - surgery; Coronary Vasospasm - complications; Coronary Vasospasm - drug therapy; Electrocardiography; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Exercise Test; Female; Follow-Up Studies; Heart Arrest - diagnosis; Heart Arrest - etiology; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Prognosis; Electrophysiology; Cardiocirculatory arrest; Prognosis; Survival
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(84)80316-2

Nineteen patients survived a cardiac arrest not associated with an acute myocardial infarction, and had a normal electrophysiologic study with no inducible ventricular tachycardia despite programmed stimulation with one to three extrastimuli at two or more ventricular sites. Among 14 patients who had obstructive coronary artery disease, cardiac arrest occurred during exertion or an episode of angina pectoris in 11; 24 hour ambulatory electrocardiographic recordings demonstrated infrequent or no premature ventricular complexes in 10 and an ischemic response occurred during stage I or II (Bruce protocol) in 6 of 9 patients who underwent exercise testing. Treatment of these patients consisted of myocardial revascularization (eight patients) or antianginal medications (six patients). Only three patients were also treated with an antiarrhythmic drug. Over a follow-up period of 26 ± 15 months (mean ± standard deviation), only one patient died suddenly.
Two patients who had coronary artery spasm were treated with coronary vasodilator medications and had no recurrence of cardiac arrest over 7 and 36 months of follow-up, respectively. Three patients who had cardiomyopathy or no identifiable structural heart disease were treated with nadolol or amiodarone and had no recurrence of cardiac arrest over 3 to 27 months of follow-up.
Among patients who survive a cardiac arrest and have a normal electrophysiologic study, those with obstructive coronary artery disease or coronary artery spasm generally have an excellent prognosis with treatment directed primarily at the underlying heart disease. The clinical features of these patients suggest that cardiac arrest was related to ischemia rather than a primary arrhythmia. The natural history of patients with a cardiomyopathy or no identifiable structural heart disease who survive a cardiac arrest and have a normal electrophysiologic study remains to be determined.