Abstract 17714: Sentinel Symptoms in Patients with Unexplained Cardiac Arrest from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER)
Methods: Patients with apparently unexplained cardiac arrest (UCA) and no evident cardiac disease (normal cardiac function on echocardiogram, no evidence of coronary artery disease and a normal ECG) underwent systematic clinical evaluation and targeted genetic testing. Patients and 1st degree relatives were interviewed to determine the presence of cardiac symptoms. UCA patients with syncope underwent 2 structured Calgary Syncope Score questionnaires to determine the probable mechanism of syncope.
Results: 100 consecutive UCA patients (age 43.0±13.4 years, 60 male) and 58 first-degree relatives were enrolled in 10 centers (age 37.7±16.1 years, 57% female). Potential cardiac symptoms were present in 71% of UCA patients compared to 40% of family members (p<0.001). Syncope was present in 26% of UCA patients, compared to 21% of family members (p=0.64). Chest pain was present in 50% of UCA patients and 12% of family members (p<0.001). Compared to non-syncopal UCA patients, patients with syncope were more likely to be female (59% vs. 33%, p=0.017), but were similar in age (42.0±12.2 vs. 44.0±14.4 years). In the 25 UCA patients that completed the syncope questionnaires, all patients had a syncope vs. seizure score <1 suggesting syncope, and 18/25 (72%) had a mechanism score <2 suggesting cardiac and not vasovagal syncope. Syncope without presyncope was present in 21 of 26 patients (81%). 60% had sought medical attention for their syncopal episode. Syncope occurred a median of 59 days before the cardiac arrest; 9 within 30 days (36%). Syncope was considered clearly related to the cause of cardiac arrest in 9 (36%). A diagnosis was obtained in 65% of patients with syncope, compared to 49% without (p=0.14), primarily with drug or exercise provocation (n=12) and advanced imaging (n=3).
Conclusions: Cardiac symptoms are common preceding unexplained cardiac arrest. Syncope precedes cardiac arrest in a quarter of patents, which may represent a sentinel event.
- © 2010 by American Heart Association, Inc.