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Europace. 2019 Aug 25. pii: euz221. doi: 10.1093/europace/euz221. [Epub ahead of print]

Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms: results from a multicentre long-term registry.

Author information

1
Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, 6900 Lugano, Switzerland.
2
Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3
Electrophysiology Department, Barts Heart Centre, Barts Health NHS trust, London, UK.
4
Cardiology Department, Arrhythmia and Electrophysiology Center IRCCS, Policlinico San Donato, Italy.
5
Cardiovascular Department, Heart Rhythm Management Centre, UZ-VUB, Jette, Brussels.
6
Cardiology Department, Arrhythmias Unit, Hospital Clinic, Barcelona, Spain.
7
Kardiologie/Elektrophysiologie Universitätsspital, Basel, Switzerland.
8
LIRYC Institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France.
9
Cardiology Department, University Hospital of Geneva, Switzerland.
10
Division of Cardiology, Policlinico Casilino, Roma, Italy.
11
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece.
12
Aston Medical Research Institute, Aston University, Birmingham, UK.
13
Guy's and St Thomas' Hospital, London, UK.
14
University Hospital Antwerp, Antwerp, Belgium.
15
Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Senese, Siena, Italy.
16
Cardiology Department, Ospedale San Francesco, Nuoro, Italy.
17
Kardiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland.
18
Cardiology Department, Parma University Hospital, Parma, Italy.
19
Division of Cardiology and Angiology, Department of Internal Medicine, Magdeburg University, Magdeburg, Germany.
20
Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy.
21
Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain.
22
Medical Sciences Department, Medical School, University of Girona, Girona, Spain.
23
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
24
Cardiology Department, Rhythmologie und invasive Elektrophysiologie, Zentralklinik Bad Berka, Bad Berka, Germany.
25
Electrophysiology Section, Department of Cardiology, OLV Hospital, Aalst, Belgium.
26
Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
27
Electrocardiology Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
28
Cardiology Department, Cardiovascular Center, American British Cowdray Medical Center, Mexico City, Mexico.
29
Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Abstract

AIMS:

To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs).

METHODS AND RESULTS:

Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03].

CONCLUSION:

Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences.

KEYWORDS:

Electrocardiography; Idiopathic ventricular fibrillation; Implantable cardioverter-defibrillator; Out-of-hospital cardiac arrest; Quinidine; Sudden cardiac death

PMID:
31504477
DOI:
10.1093/europace/euz221

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