Circulation, Vol 82, 341-349, Copyright © 1990 by American Heart Association
MJ Silka, J Kron, CG Walance, JE Cutler and JH McAnulty
In the young patient resuscitated from sudden cardiac arrest, the risks of
recurrence are uncertain and so are the criteria defining therapeutic
efficacy for the presumed cause of the initial event. In this study, we
analyzed the outcome of 15 consecutive young patients, who were
resuscitated from pulseless ventricular tachycardia or ventricular
fibrillation and who were evaluated by comprehensive hemodynamic and
electrophysiological testing. Patients were 11.2 +/- 2.7 (mean +/- SD)
years old at the time of their event, and each was known to have some form
of heart disease before sudden cardiac arrest. Ventricular tachycardia or
fibrillation was inducible by programmed electrical stimulation in eight
patients. Accessory atrioventricular connections, with antegrade effective
refractory periods less than 220 msec, were identified in three patients.
Sustained atrial flutter was the only arrhythmia inducible in two patients,
and no arrhythmias were inducible in two other patients. Surgical or
electrophysiological- guided medical therapy resulted in noninducibility of
the ventricular arrhythmias in six patients. Surgical division of the
accessory atrioventricular connections was performed in three patients, and
arrhythmias were not inducible after operation. The four patients with
atrial flutter or without defined arrhythmia were treated with an empiric
therapy. During 37 +/- 14 months of follow-up, the nine patients with
documented noninducibility of a defined cause of sudden cardiac arrest were
free of recurrent events. In contrast, during 18 +/- 10 months of
follow-up, two of the six patients with empiric therapy or persistent
inducibility of ventricular tachycardia died suddenly, and three others had
recurrence of ventricular tachycardia or fibrillation.(ABSTRACT TRUNCATED
AT 250 WORDS)
ARTICLES
Assessment and follow-up of pediatric survivors of sudden cardiac death
Department of Pediatrics, Oregon Health Sciences University, Portland 97201-3098.
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