Abstract 13458: LV Systolic Function in Subjects Presenting with Non-VF/VT Sudden Cardiac Arrest
Introduction: Corresponding to a decrease in the incidence of ventricular fibrillation or tachycardia (VF/VT) there is a significant and unexplained increase in the proportion of sudden cardiac arrest presenting with pulseless electrical activity (PEA). From the cardiac standpoint, PEA is thought to occur with end-stage heart disease and pump failure but this warrants further investigation in the community. We hypothesized that there are differences in the LV systolic function among presenting arrhythmias.
Methods: Cases of out of hospital sudden cardiac arrest, age ≥18 years, with LV ejection fraction (LVEF) assessment were identified from an ongoing prospective community-based study in the Northwest US (pop. approx. 1 million). EF was determined from echocardiogram, angiogram, or multi-gated acquisition scan prior and unrelated to the cardiac arrest (median 13.8 months, IQ range 4.1-30.2 months). Pearson’s x2 tests and analysis of variance were used for comparisons of presenting arrhythmia, arrest circumstances and LV systolic function.
Results: A total of 428 cases (mean age 69±13 years, 68% male) with ante-mortem LVEF assessment presented with VF/VT (48%), PEA (23%) or asystole (29%). PEA cases were older and more likely to be female (p≤0.02). VF/VT cases were more likely to be witnessed, to arrest in public locations, to have return of spontaneous circulation and to survive to hospital discharge (p≤0.0001). There was no significant difference in the response time between presenting arrhythmias (p=0.63). PEA and asystole cases were more likely to have normal LV function, while severe LV dysfunction was more common in VF/VT (p=0.02). EF ≥50% was present in 61% of PEA, 62% of asystole and 43% of VF/VT cases (p=0.0006). Among patients with EF ≥50%, coronary artery disease was present in 53% of cases with no difference by presenting arrhythmia.
Conclusion: Contrary to expectations, a significant subgroup of patients manifesting with PEA and asystole had preserved LV systolic function prior to sudden cardiac arrest.
- © 2012 by American Heart Association, Inc.