Clinical Characteristics and Management of Aborted Sudden Cardiac Arrest in Children: How is The Situation in Developing Countries?

Purpose Sudden cardiac arrest (SCA) in children is very rare, it has various causes. In this study, we provided an overview of SCA survivors and evaluated investigations for aetiology with management in our center. Methods We identified 59 pediatric patients with aborted SCA (aSCA) only documented by the healthcare professionals (emergency physician, pediatrician, and pediatric cardiologist) between March 2010 and December 2021. Clinical history, non-invasive and invasive diagnostic tests and therapies were noted from FileMaker® Database. Results The mean ± standard deviation age of patients was 9,6 ± 5.5 years (2 month-21 years) and 55.9% were male. Echocardiography and other imaging tests revealed structural heart disease (group 1) in 18 patients (30.5%). 37 patients (62.8%) had electrical heart disease (group 2) and no cause was found in the remaining four patients (Table 1). Hypertrophic cardiomyopathy was the most common cause (4/18, 22%) in the first group. Long QT syndrome (LQTS) was the most common cause (12/17, 32.4%) in the second group. 46 patients (78%) had SCA as the first manifestation of heart disease. While SCA occurred with exertion in 14 patients (23.7%), SCA developed in 38 patients (64.7%) at rest. According to the information obtained from the data, the most common documented cardiac arrest rhythm was ventricular fibrillation in 15 patients (25.4%). The median intensive care unit follow-up period of survivors after sudden cardiac arrest was 7 days (2–46 days). Neurological sequelae remained in 10 (16.9%) patients after aSCD. 15 patients (25.4%) underwent electrophysiological study and/or ablation. ICD implantation was performed in 44 (74.6%) patients (29 transvenous, 14 epicardial, 1 cardiac resynchronization therapy-defibrillator (CRT-D)). ICD was not implanted in 15 patients. Of these, 7 patients did not require ICD due to definitive treatment (successful ablation therapy, surgical coronary reimplantation, pacemaker implantation). ICD could not be inserted because 4 patients died. 4 patients and their families refused ICD. The median follow-up duration for patients was 1091 days (range: 15–4225 days). 9 patients (15.3%) died during the follow-up. Conclusions The etiology of aSCA is very variable and present at any age. Detailed non-invasive and invasive investigations are crucial in revealing the diagnosis. Appropriate treatment and secondary preventive ICD implantation are life-saving route for selected SCA survivors. In our country, there is a need to increase basic life support training, use of automatic external defibrillators in public spaces and develop genetic research.