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Ventricular Arrhythmias and Sudden Cardiac Death (SCD)

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 December 2023) | Viewed by 8981

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Dr. Tasuku Matsuyama

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Guest Editor

Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
Interests: cardiac arrest; emergency medicine; critical care; clinical epidemiology; implementation science

Special Issue Information

Dear Colleagues,

Sudden cardiac death (SCD) is an important public health problem. Despite the advances in resuscitation science and practices, the outcome after SCD remains poor. The “chain of survival” is the key concept to improve outcomes of patients experiencing cardiac arrest (CA).

Currently, there is space to improve the quality in each link. For example, “Rapid defibrillation” is one of the links for shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia). However, three-quarters of them failed to achieve a sustained return of spontaneous circulation after initial defibrillation, which suggests the need for evidence about the appropriate next resuscitation strategy for patients with refractory CA such as extracorporeal cardiopulmonary resuscitation (CPR). “High-quality CPR” is another link. To confirm “high-quality”, measuring the quality of CPR such as using real-time feedback devices is essential. More importantly, the appropriate method of CPR may depend on the person. Therefore, real-time physiological monitor during CPR may improve after CA. In addition, further evidence about effective prevention strategies for sudden cardiac death or post CA care should be accumulated.

In this Special Issue, we aim to bring together a number of reviews including systematic reviews or original articles with a broad range of evidence from prevention to post-resuscitation care about sudden cardiac death.

Dr. Tasuku Matsuyama
Guest Editor

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Keywords

sudden cardiac death
ventricular arrhythmia
prevention of sudden cardiac death
out-of-hospital cardiac arrest
in-hospital cardiac arrest
cardiopulmonary resuscitation
physiological monitoring
feedback device
ECPR (Extracorporeal cardiopulmonary resuscitation)
post cardiac arrest care

Published Papers (7 papers)

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Research

11 pages, 980 KiB

Open AccessArticle

Transnasal Evaporative Cooling in Out-of-Hospital Cardiac Arrest Patients to Initiate Hypothermia—A Substudy of the Target Temperature Management 2 (TTM2) Randomized Trial

by Akil Awad, Emelie Dillenbeck, Josef Dankiewicz, Mattias Ringh, Sune Forsberg, Leif Svensson, Andreas Claesson, Jacob Hollenberg and Per Nordberg

J. Clin. Med. 2023, 12(23), 7288; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12237288 - 24 Nov 2023

Viewed by 1019

Abstract

Background: In animal models, early initiation of therapeutic cooling, intra-arrest, or restored circulation has been shown to be neuroprotective shortly after cardiac arrest. We aimed to assess the feasibility and cooling efficacy of transnasal evaporative cooling, initiated as early as possible after hospital arrival in patients randomized to cooling in the TTM2 trial. Methods: This study took the form of a single-center (Södersjukhuset, Stockholm) substudy of the TTM2 trial (NCT02908308) comparing target temperature management (TTM) to 33 °C versus normothermia in OHCA. In patients randomized to TTM33 °C, transnasal evaporative cooling was applied as fast as possible. The primary objectives were the feasibility aspects of initiating cooling in different hospital locations (i.e., in the emergency department, coronary cathlab, intensive care unit (ICU), and during intrahospital transport) and its effectiveness (i.e., time to reach target temperature). Transnasal cooling was continued for two hours or until patients reached a core temperature of <34 °C. Cooling intervals were compared to participants at the same site who were randomized to hypothermia and treated at 33 °C but who for different reasons did not receive transnasal evaporative cooling. Results: From October 2018 to January 2020, 32 patients were recruited, of which 17 were randomized to the TTM33. Among them, 10 patients (8 men, median age 69 years) received transnasal evaporative cooling prior to surface systemic cooling in the ICU. In three patients, cooling was started in the emergency department; in two patients, it was started in the coronary cathlab, and in five patients, it was started in the ICU, of which three patients were subsequently transported to the coronary cathlab or to perform a CT scan. The median time to initiate transnasal cooling from randomization was 9 min (range: 5 to 39 min). The median time from randomization to a core body temperature of 34 °C was 120 min (range 60 to 334) compared to 178 min among those in the TTM33 group that did not receive TNEC and to 33 °C 230 min (range: 152 to 351) vs. 276 min (range: 150 to 546). No feasibility or technical issues were reported. No adverse events occurred besides minor nosebleeds. Conclusions: The early induction of transnasal cooling in out-of-hospital cardiac arrest patients was feasible to initiate in the emergency department, coronary cathlab, ICU, and during intrahospital transport. Time to target temperature was shortened compared to standard cooling. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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13 pages, 1037 KiB

Open AccessArticle

Prevention of Early Sudden Cardiac Death after Myocardial Infarction Using the Wearable Cardioverter Defibrillator—Results from a Real-World Cohort

by Ursula Rohrer, Martin Manninger, Lukas Fiedler, Clemens Steinwender, Ronald K. Binder, Markus Stühlinger, Birgit Zirngast, David Zweiker, Andreas Zirlik and Daniel Scherr

J. Clin. Med. 2023, 12(15), 5029; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12155029 - 31 Jul 2023

Cited by 1 | Viewed by 674

Abstract

Background: After acute myocardial infarction (AMI), patients are at risk of sudden cardiac death. The VEST trial failed to show a reduction in arrhythmic mortality in AMI patients with an LVEF ≤ 35% prescribed with a WCD, having a lower-than-expected WCD wearing compliance. Objectives: The aim was to investigate on outcomes of patients in a real-world Austrian cohort with good compliance. Methods: A retrospective analysis of all eligible Austrian WCD patients according to the VEST trial inclusion and exclusion criteria between 2010 and 2020 was performed. Results: In total, 105 Austrian patients (64 ± 11 years, 12% female; LVEF 28 ± 6%) received a WCD for a median of 69 (1; 277) days after AMI (wearing duration 23.5 (0; 24) hours/day). Within the first 90 days, 4/105 (3.8%) patients received 9 appropriate shocks (2 (1; 5) shocks). No inappropriate shocks were delivered, and 3/105 (2.9%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, p = 0.52), as well as all-cause mortality (2.9% vs. 3.1%, p = 0.42) was comparable in both cohorts. Conclusions: The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤ 35% after AMI. However, despite excellent WCD wearing duration in our cohort, the arrhythmic mortality rate was not significantly different. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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12 pages, 589 KiB

Open AccessArticle

Wearable Cardioverter Defibrillator Shortens the Lengths of Stay in Patients with Left Ventricular Dysfunction after Myocardial Infarction: A Single-Centre Real-World Experience

by Laura Sofia Cardelli, Quentin Delbaere, François Massin, Mathieu Granier, Gianni Casella, Gaetano Barbato, Valentin Dupasquier, Jean-Christophe Macia, Florence Leclercq, Jean-Luc Pasquie and François Roubille

J. Clin. Med. 2023, 12(15), 4884; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12154884 - 25 Jul 2023

Viewed by 954

Abstract

The wearable cardioverter defibrillator (WCD) has been proven to be effective in preventing sudden cardiac death (SCD) in patients soon after acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤35%. The aim of this study was to assess whether a WCD may shorten the length of an initial hospital stay (total length, days in the intensive care unit (ICU) and in the acute cardiac care unit (ACCU)) among these patients. This was a single-centre, retrospective observational study of patients referred for the management of SCD risk post-AMI and LVEF ≤35%, in a tertiary care hospital. The clinical characteristics and length of index hospitalization of the group of patients discharged, with or without WCD, were compared. A propensity score analysis was performed, then weighted regression models were conducted. A total of 101 patients in the WCD group and 29 in the control group were enrolled in the analysis. In the weighted regression models, WCD significantly reduced the days spent in ACCU (p < 0.001). WCD patients had significantly fewer days spent in ACCU (5.5 ± 2.6 vs. 8.4 ± 12.8 days, p < 0.001) and shorter hospitalizations (10.2 ± 5.7 vs. 13.4 ± 17.6 days, p = 0.005), compared with the control group. It was concluded that the WCD appears to reduce the total length of hospitalization and lengths of stay in ACCU for patients post-AMI and with left ventricular dysfunction. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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9 pages, 1015 KiB

Open AccessArticle

Does Patient Compliance Influence Wearable Cardioverter Defibrillator Effectiveness? A Single-Center Experience

by Luca Fazzini, Maria Francesca Marchetti, Ferdinando Perra, Mattia Biddau, Nicola Massazza, Vincenzo Nissardi, Elena Agus, Roberta Demelas and Roberta Montisci

J. Clin. Med. 2023, 12(14), 4743; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12144743 - 18 Jul 2023

Cited by 1 | Viewed by 878

Abstract

The study was designed to assess patient adherence to wearable cardioverter defibrillator as an indicator of device effectiveness. The patient training is not widely properly standardized. We enrolled 25 patients with a wearable cardioverter defibrillator to prevent sudden cardiac death between June 2020 and August 2022. Among them, 84% were male with a median age of 63.6 years. The indication was an ischemic (44%) and a non-ischemic (56%) disease. The patients were followed-up until the decision to upgrade to an implantable device was taken. We trained the patients according to our suggested protocol. The median wear time was 90 days, and the median daily wear time was 23.5 h, similar throughout sex, age, and indication groups. In total, 24% of the participants underwent cardioverter defibrillator implantation. Between the device-implanted and non-implanted groups, left ventricular ejection fraction and left ventricular indexed end-diastolic volume were significantly different (EF 35.8 ± 12 vs. 46.4 ± 8.5%, p = 0.028, iEDV 108 ± 52 vs. 70.7 ± 21.1 mL/m², p = 0.024). We did not find any differences in cardiac magnetic resonance data, even though all patients who underwent device implantation had late gadolinium enhancement spots. Our results support standardized patient training to obtain great patient adherence to the instructions to the wearable device and therefore its effectiveness. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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12 pages, 1469 KiB

Open AccessArticle

Differences in Cerebral Oxygenation in Cardiogenic and Respiratory Cardiac Arrest Before, During, and After Cardiopulmonary Resuscitation

by Yasuaki Koyama, Akira Ouchi, Nobutake Shimojo and Yoshiaki Inoue

J. Clin. Med. 2023, 12(8), 2923; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12082923 - 18 Apr 2023

Viewed by 1107

Abstract

We compared the changes in cerebral oxygen saturation (ScO₂) levels during cardiac arrest (CA) events using porcine models of ventricular fibrillation CA (VF-CA) and asphyxial CA (A-CA). Twenty female pigs were randomly divided into VF-CA and A-CA groups. We initiated cardiopulmonary resuscitation (CPR) 4 min after CA and measured the cerebral tissue oxygenation index (TOI) using near-infrared spectroscopy (NIRS) before, during, and after CPR. In both groups, the TOI was the lowest at 3–4 min after pre-CPR phase initiation (VF-CA group: 3.4 min [2.8–3.9]; A-CA group: 3.2 min [2.9–4.6]; p = 0.386). The increase in TOI differed between the groups in the CPR phase (p < 0.001); it increased more rapidly in the VF-CA group (16.6 [5.5–32.6] vs. 1.1 [0.6–3.3] %/min; p < 0.001). Seven pigs surviving for 60 min after the return of spontaneous circulation in the VF-CA group recovered limb movement, whereas only one in the A-CA group (p = 0.023) achieved movement recovery. The increase in the TOI did not differ significantly between the groups in the post-CPR phase (p = 0.341). Therefore, it is better to monitor ScO₂ concomitantly with CPR initiation using NIRS to assess the responsiveness to CPR in clinical settings. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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9 pages, 3507 KiB

Open AccessArticle

Novel Mode of Near-Infrared Spectroscopy as a Continuous Cerebral Physiological Monitoring Device during Cardiopulmonary Resuscitation: Four Case Reports

by Tasuku Matsuyama, Yuki Yasutake, Daichi Inaba, Hideaki Yoshihara, Keisuke Bando, Toshihisa Matsui, Masaki Nagama and Hitoshi Kano

J. Clin. Med. 2022, 11(7), 2018; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11072018 - 04 Apr 2022

Cited by 2 | Viewed by 1481

Abstract

Background: NIRO-Pulse is a novel mode of near-infrared spectroscopy that can be used to visually evaluate cerebral perfusion during cardiopulmonary resuscitation (CPR), providing real-time feedback as to the quality of the CPR. The aim of this report was to describe the several representative cases of NIRO-Pulse for physiological monitoring during CPR. Methods: We present several cases from out-of-hospital cardiac arrest (OHCA) patients for whom NIRO-Pulse was attached to the forehead after hospital arrival. Patients were subjected to continuous brain monitoring during CPR using NIRO-Pulse, which allows for the visualisation of ΔHb (Hb pulsation). NIRO-Pulse is capable of simultaneously measuring and displaying cerebral tissue oxygen saturation (SctO2) and Hb pulsation, providing real-time feedback during CPR in the form of physiological indicators, and assessing changes in SctO2 throughout the CPR procedure by post-mortem analysis. Results: We observed several representative cases that provided the following insights: (1) SctO2 increased after a change in the quality of chest compression, (2) SctO2 decreased during the ventilation phase of synchronised CPR, (3) SctO2 decreased during the interruption of chest compressions for the preparation of defibrillation, and (4) SctO2 gradually and continuously increased after return of spontaneous circulation. Conclusion: Displaying Hb pulsation in conjunction with SctO2 during CPR may be helpful for evaluating the quality of and patient responsiveness to CPR. Further studies investigating the association between the use of NIRO-Pulse during CPR and subsequent outcomes should be conducted. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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12 pages, 1282 KiB

Open AccessArticle

Dissemination of Chest Compression-Only Cardiopulmonary Resuscitation by Bystanders for Out-of-Hospital Cardiac Arrest in Students: A Nationwide Investigation in Japan

by Kosuke Kiyohara, Yuri Kitamura, Mamoru Ayusawa, Masahiko Nitta, Taku Iwami, Ken Nakata, Tomotaka Sobue and Tetsuhisa Kitamura

J. Clin. Med. 2022, 11(4), 928; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11040928 - 10 Feb 2022

Cited by 2 | Viewed by 1891

Abstract

We aimed to investigate how the types of bystander-initiated cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) among students have changed recently. We also determined the association between two types of bystander-CPRs (i.e., chest compression-only CPR [CCCPR] and conventional CPR with rescue breathing [CCRB]) and survival after OHCA. From a nationwide registry of pediatric OHCAs occurring in school settings in Japan, the data of 253 non-traumatic OHCA patients (elementary, junior high, and high school/technical college students) receiving bystander-CPR between April 2008 and December 2017 were analyzed. Multivariable logistic regression analysis was conducted to assess the impact of different types of bystander-CPR on 30-day survival with favorable neurological outcomes. The proportion of patients receiving CCCPR increased from 25.0% during 2008–2009 to 55.3% during 2016–2017 (p for trend < 0.001). Overall, 53.2% (50/94) of patients receiving CCCPR and 46.5% (74/159) of those receiving CCRB survived for 30 days with favorable neurological outcomes. Multivariable analysis showed no significant difference in outcomes between the two groups (adjusted odds ratio: 1.23, 95% confidence interval: 0.67–2.28). In this setting, CCCPR is a common type of bystander-CPR for OHCA in students, and the effectiveness of CCCPR and CCRB on survival outcomes seems comparable. Full article

(This article belongs to the Special Issue Ventricular Arrhythmias and Sudden Cardiac Death (SCD))

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