Idiopathic? The Importance of Comprehensive Evaluations of Survivors of Cardiac Arrest

Idiopathic? The Importance of Comprehensive Evaluations of Survivors of Cardiac Arrest

Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation

Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific etiology can be unmasked by a careful evaluation. A new study from the Paris Sudden Death Expertise Center (Paris-SDEC) looked at how often patients with unexplained SCA receive systematic and thorough investigation in real-world practice.

Researchers analyzed the medical records of all patients in the Paris-SDEC registry who survived to hospital discharge following out-of-hospital cardiac arrest. Data collection was standardized for all cases and included demographic characteristics, location of arrest, pre-hospital data, past medical history, final diagnoses, preventive measures implemented, and vital status and neurological outcome at hospital discharge.

This study shows the extent to which unexplained cardiac arrest is inadequately evaluated in the real-world setting. Fewer than 20 percent of patients labeled with idiopathic ventricular fibrillation received a comprehensive evaluation.

Previous studies have shown that systematic evaluation that utilizes provocative, exercise, and genetic testing may allow the identification of a definitive diagnosis in >50 percent of otherwise unexplained SCA. These results demonstrate a gap between results from tertiary specialized electrophysiology teams and unselected real-world hospitals and the importance of referring these patients to expert centers.

Findings suggest that systematic, comprehensive cardiac evaluation is significantly underutilized in the community, leading to overuse of the diagnosis of idiopathic ventricular fibrillation. These findings merit the implementation of a standardized and systematic diagnostic approach for the evaluation of unexplained SCA.

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SOURCE: American College of Cardiology

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