2004, Number 4
<< Back Next >>
Arch Cardiol Mex 2004; 74 (4)
Sudden death due to electrical causes in individuals without demonstrable structural cardiac disease. Experience in Cuba
Dorantes SM, Castro HJ, Tornés BF, Quiñones PMA, Zayas MR, Dorticós BF
Language: Spanish
References: 20
Page: 283-289
PDF size: 144.78 Kb.
ABSTRACT
Sudden cardiac death due to electrical causes in individuals with no evidence of structural heart disease is an important clinical and public health problem, and it is not yet solved. The objectives of this study were: to characterize patients reanimated from a sudden death event of electrical cause; to know the mediated evolution during a period of three years and to study premonitory electrical signs. 42 individuals were studied, 30 were male and 12 female, mean age 37.7 years, healthy heart, by clinic and paraclinic methods. Nine subpopulations were studied, being Brugada syndrome, long QT syndrome and idiopathic ventricular fibrillation the most frequent. Ventricular fibrillation and twisting of the points were the arrhythmias responsible for most death events. There were premonitory signs in 92.8% and clinical recurrences of life-threatening events in 71.4% but they were induced during programmed electrical stimulation only in 4 of 18 patients. Atrial fibrillation was the most frequent coexistent arrhythmia (19%). In summary, there are frequent premonitory signs (particularly atrial fibrillation), and also malignant arrhythmic recurrences but a poor inducibility at the electrophysiology laboratory. It is very difficult to stratify the risk because of the low predictive value of diagnostic methods.
REFERENCES
Consensus Statement of the Joint Steering Committees of the Unexplained Cardiac Arrest Registry of Europe and of the Idiopathic Ventricular Fibrillation Registry of the United States: survivors of out-of -hospital cardiac arrest with apparently normal heart. Need for definition and standardized clinical evaluation. Circulation 1997; 95: 265-72.
Zipes DP, Wellens HJ: Sudden cardiac death. Circulation 1998; 98: 2334-51.
Priori S G, Aliot E, Blomstrom-Lundquist C, Bossaert L, Breithardt G, Brugada P, et al: Task Force on Sudden Cardiac Death of the European Society of Cardiology and the American College of Cardiology. Eur Heart J 2001; 22: 1374-450.
Chugh SS, Kelly KL, Titus JL: Sudden cardiac death with apparently normal heart. Circulation 2000; 102: 649-58.
Rodríguez FE, Viñolas PX: Causas de muerte súbita. Problemas a la hora de establecer y clasificar los tipos de muerte. Rev Esp Cardiol 1999; 52: 1004-14.
Gilman JK, Jalal S, Naccarelli GV: Predicción y prevención de la muerte súbita de causa cardíaca. Circulation (ed. española) 1995; 2: 53-65.
Dorantes M, Dorticós F, Arbaiza JL, Zayas R, Castro J, Quiñones MA, Fayad Y: Muerte súbita de causa eléctrica en pacientes con corazón estructuralmente sano. Edición Latina de Electrocardiología 2002; 8: 22-25.
Antzelevitch C: Molecular biology and cellular mechanisms of Brugada and long QT syndromes in infants and young children. J Electrocardiol 2001; 34(suppl): 177-81.
Stanley J, Alvarez J, Dorantes M, Castro J, Barrera D, Stusser R, et al: Marcadores no invasivos en pacientes con síndrome de Brugada. 3rd International Congress of Cardiology on the Internet. Argentine Federation of Cardiology, IX-XI 2003.
Antzelevitch C, Yan GX, Shimizu W, Burashnikov A: Electrical heterogeneity, the ECG and cardiac arrhythmias. In: Zipes DP, Jalife J eds. Cardiac electrophysiology: from cell to bedside. 3rd ed Philadelphia. WB Saunders, 1998, p 26-1, 26-34.
Rosenbaum DS, Albrecht P, Cohen RJ: Predicting sudden cardiac death from T-wave alternans of the surface electrocardiogram: promise and pitfalls. J Cardiovasc Electrophysiol 1996; 7: 1095-111.
Antzelevitch C: Late potentials and the Brugada syndrome. JACC 2002; 39: 1996-9.
Ikeda T, Sakurada H, Sakabe K, Sakata T, Takami M, Tezuka N, et al: Assessment of non-invasive markers in identifying patients at risk in the Brugada syndrome: insight into risk stratification. JACC 2001; 37: 1628-34.
Huikuri HV: Heart rate dynamics and vulnerability to ventricular tachyarrhythmias. Ann Med 1997; 28: 321-5.
Antzelevitch C, Shimizu W, Yan GX, Sicouri S: Cellular basis for QT dispersion. J Electrocardiol 1998; 30 (suppl): 168-75.
Kautzner J, Yi G, Camm AJ, Malik M: Short and long-term reproducibility of QT, QTc and QT dispersion in healthy subjects. PACE 1994; 17: 928-37.
Wilde AAM, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, et al: Proposed diagnostic criteria for the Brugada syndrome. Consensus report. Circulation 2002; 106: 2514-24.
Dorticós BF, Dorantes SM, Arbaiza SJL, Castro HJ, Zayas MR, Quiñones PMA, Fayad RY: Síndrome de Brugada: experiencia cubana 2002. Arch Cardiol Méx 2002; 72: 203-8.
Marcus FI: Idiopathic ventricular fibrillation. J Cardiovasc Electrophysiol 1997; 8: 1075-83.
Belhassen B, Viskin S, Antzelevitch C: The Brugada syndrome: is an implantable cardioverter defibrillator the only therapeutic option? PACE 2002; 25: 1634-40.