Ventricular tachyarrhythmia was the precursor of sudden cardiac death in 80% (12 of 15) of monitored patients, with torsade de pointes being a frequent cause.
Observational (n=15)
Ventricular tachyarrhythmias, particularly torsade de pointes, are the most frequent precursors to sudden cardiac death in hospitalized patients.
To determine the cardiac rhythm disturbances underlying sudden death, 15 patients (14 inpatients and 1 outpatient) who had cardiac arrest unexpectedly while undergoing ambulatory electrocardiographic monitoring were identified. Heart disease was present in 11 patients and 7 patients were admitted to the hospital with chest pain before sudden cardiac death occurred. The terminal event at the time of cardiac arrest in 3 (20%) of the 15 patients was a bradyarrhythmia expressed as complete heart block; none survived. A ventricular tachyarrhythmia was the precursor of sudden cardiac death in the remaining 12 patients (80%). Two of these 12 had slow ventricular tachycardia and both died. Five had polymorphous ventricular tachycardia associated with prolonged QT interval (torsade de pointes) and three were receiving a class I antiarrhythmic agent. This rhythm degenerated into ventricular fibrillation in one patient; four of the five patients survived after electrical cardioversion. One patient had ventricular tachycardia followed by asystole. Four patients had ventricular flutter (rate greater than 250/min) that degenerated into ventricular fibrillation in each case; only one of these four patients survived after cardioversion. Frequent (greater than 30/h) premature ventricular complexes were present in 9 of 10 patients with ventricular tachycardia or flutter and R on T phenomenon was seen in only 1 patient. In conclusion, a ventricular tachyarrhythmia is usually found on Holter monitoring during sudden cardiac death in hospitalized patients; torsade de pointes (polymorphous ventricular tachycardia) is a frequent cause of sudden death in these patients. Ventricular fibrillation is always preceded by ventricular tachycardia or ventricular flutter.
Panidis et al. (Tue,) conducted a observational in Sudden cardiac death (n=15). Ambulatory electrocardiographic monitoring was evaluated on Cardiac rhythm disturbances underlying sudden death. Ventricular tachyarrhythmia was the precursor of sudden cardiac death in 80% (12 of 15) of monitored patients, with torsade de pointes being a frequent cause.