American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms.

To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes.

Background: ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI. Methods: This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed. Results: During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group. Conclusion: In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.

Current behavior of sudden cardiac arrest and sudden death.

Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.

El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.

Current behavior of sudden cardiac arrest and sudden death / Comportamiento actual del paro cardíaco súbito y muerte súbitos

Abstract Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.

Resumen El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.

Current behavior of sudden cardiac arrest and sudden death.

Sudden cardiac arrest (SCA) and sudden death (SD) continues to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCD victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity (PEA) are detected more frequently than ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.

El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.

Cardiopulmonary Resuscitation Training Disparities in the United States.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual-level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training. METHODS AND RESULTS: We administered a cross-sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97-0.99; P<0.01; ever trained: OR, 0.99; 95% CI, 0.98-0.99; P=0.04). Furthermore, there was a greater then 4-fold difference in odds of being currently CPR trained from the 30-39 to 70-79 year old age groups (95% CI, 0.10-0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income (P<0.01 for each of these variables). CONCLUSIONS: A minority of respondents reported current training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability.

Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest.

OBJECTIVES: To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). STUDY DESIGN: This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014. RESULTS: A total of 450 patients (257 male/193 female; median age 10.1 years [3.6-13.8 years, 25th-75th percentiles]) were enrolled. Patient age was ≤13 years for 70.4% of the cohort (n = 317). Sudden cardiac arrest was the initial presentation in 7%; others were referred on the basis of abnormal or suspicious family history, personal symptoms, or physical findings. Patients with LQTS and hypertrophic cardiomyopathy were referred most commonly because of family history concerns. ALCA-R was most likely to have abnormal signs or symptoms (eg, exercise chest pain, syncope, or sudden cardiac arrest). Patients with CPVT had a high incidence of syncope and the greatest incidence of sudden cardiac arrest (45%); 77% exhibited exercise syncope or sudden cardiac arrest. This study demonstrated that suspicious or known family history plays a role in identification of many patients ultimately affected by 1 of the 3 genetic disorders (hypertrophic cardiomyopathy, LQTS, CPVT). CONCLUSION: Important patient and family history and physical examination findings may allow medical providers to identify many pediatric patients affected by 4 cardiac disorders predisposing to sudden cardiac arrest.

Sudden cardiac arrest in hemodialysis patients with wearable cardioverter defibrillator.

BACKGROUND: The survival outcome following a sudden cardiac arrest (SCA) in hemodialysis (HD) patients is poor regardless of whether an event takes place in or out of a dialysis center. The characteristics of SCA and post-SCA survival with HD patients using a wearable cardioverter defibrillator (WCD) are unknown. METHODS: All HD patients who were prescribed a WCD between 2004 and 2011 and experienced at least one SCA event were included in this study. Demographics, clinical background, characteristics of SCA events were identified from the manufacturer's database. An SCA event was defined as all sustained ventricular tachycardia/fibrillation (VT/VF) or asystole occurring within 24 hours of the index arrhythmia episode. The social security death index was used to determine mortality after WCD use. RESULTS: A total of 75 HD patients (mean age = 62.9 ± 11.7 years, female = 37.3%) experienced 84 SCA events (119 arrhythmia episodes) while wearing the WCD. Sixty six (78.6%) SCA events were due to VT/VF and 18 (21.4%) were due to asystole. Most SCA episodes occurred between 09:00 and 10:00 (RR = 2.82, 95% CI [1.05, 7.62], P < 0.0001), followed by the 13:00-14:00 time interval (RR = 2.22, 95% CI [0.79, 6.21], P = 0.006). Acute 24-hour survival was 70.7% for all SCA events; 30-day and 1-year survival were 50.7% and 31.4%, respectively. Women had a better post-SCA survival than men (HR = 2.41, 95% CI [1.09, 5.36], P = 0.03). CONCLUSIONS: The use of WCD in HD patients was associated with improved post-SCA survival when compared to historical data.

Emergency response planning and sudden cardiac arrests in high schools after automated external defibrillator legislation.

OBJECTIVE: To compare medical emergency response plan (MERP) and automated external defibrillator (AED) prevalence and define the incidence and outcomes of sudden cardiac arrest (SCA) in high schools before and after AED legislation. STUDY DESIGN: In 2011, Tennessee Secondary School Athletic Association member schools were surveyed regarding AED placement, MERPs, and on-campus SCAs within the last 5 years. Results were compared with a similar study conducted in 2006, prior to legislation requiring AEDs in schools. RESULTS: Of the schools solicited, 214 (54%, total enrollment 182 289 students) completed the survey. Compared with 2006, schools in the 2011 survey had a significantly higher prevalence of MERPs (84% vs 71%, P < .001), annual practice (56% vs 36%, P < .001), medical emergency communication systems (80% vs 62%, P < .001), and defibrillators (90% vs 47%, P < .001). No differences were noted in the prevalence of cardiopulmonary resuscitation training (20% vs 17%, P = .58) or full compliance with American Heart Association guidelines (11% vs 7%, P = .16). Twenty-two SCA victims were identified, yielding a 5-year incidence of 1 in 10 schools. CONCLUSIONS: After state legislation, schools demonstrated a significant increase in MERPs and on-campus defibrillators but rates of cardiopulmonary resuscitation training and overall compliance with guidelines remained low.

Muerte súbita cardiaca: Las siete preguntas para las cuales todo cardiólogo debe tener respuesta / Sudden cardiac death: the 7 questions all cardiologists must have an answer to

El cardiodesfibrilador implantable ha revolucionado la prevención y el tratamiento de la muerte súbita cardiaca. A pesar de ello subsisten dudas en cuanto a su indicación en diversas circunstancias de la práctica clínica diaria. Algunas respuestas para los principales interrogantes se describen a continuación: 1. de acuerdo a las estadísticas mundiales la incidencia anual de muerte súbita varía entre 750 y 1000 muertes súbitas cardiacas por millón de habitantes, y el 80% se relacionan con cardiopatía isquémica. 2. Mientras aproximadamente un cuarto de las muertes súbitas ocurren en sujetos con antecedentes severos de enfermedad cardiaca y deterioro de la función ventricular, en el 75% restante el episodio se desarrolla en individuos con escasos antecedentes o sin ellos y con funciones ventriculares normales. 3. En sujetos con antecedentes previos, el riesgo de desarrollar arritmias letales no decrece con el paso del tiempo, y puede desarrollarse muchos años después del episodio que marcó el inicio de la enfermedad. 4. La Terapia farmacológica puede actuar como co-adyudante para disminuir el riesgo arrítmico, pero no reemplaza la indicación del cardiodesfibrilador de acuerdo a las guías actuales. 5. El estudio electrofisiológico, no ha demostrado ser eficaz en la estratificación del riesgo de muerte súbita cardiaca. 6. En individuos con escasos antecedentes y sin deterioro de la función ventricular, y en la población general que consulta al cardiólogo, los antecedentes familiares de muerte súbita a temprana edad, y la observación de patrones electrocardiográficos específicos (onda delta, QT largo, etc.), pueden ser las únicas alertas que nos lleven a investigar un posible candidato a la muerte súbita. 7. A pesar de la descripción de choques inapropiados y de eventualmente daño miocárdico asociado a la terapia de choque, el cardiodesfibrilador continúa siendo la terapia de elección en la prevención y tratamiento de la muerte súbita arrítmica.

The implantable cardioverter defibrillator (ICD), has changed the view related to prevention and treatment of sudden cardiac arrest (SCA). However, some issues are still matter of discussion. Answers for the main questions are briefly exposed. 1. According to worldwide statistics, the annual incidence of SCA varies between 750 and 1000 people per million inhabitants. 2. Nearly 25% of SCA are related to individuals with severe heart disease and low ejection fraction, but in the remaining 75% there are scarce or no antecedents at all, plus normal left ventricular function. 3. In subjects with history of severe heart disease, the risk of SCA does not decrease along the time. 4. Pharmacological treatment did not prove to be safe for SCA prevention and cannot replace the ICD indication. 5. Except in particular cases, EP testing is not the right tool for risk stratification of SCA. 6. In the population with minor or without antecedents of heart disease, family history of SCA below 40 years old, or some features in the ECG (delta wave, long QT interval, etc), would be the unique sign of risk for developing SCA. 7. Although inappropriate shocks and eventually myocardial injury due to shock therapy may occur, the ICD still is the best therapy for prevention and treatment of SCA.