Changes in paced signals may predict in‐hospital cardiac arrest

Abstract

Background: An increasing number of patients with chronic illnesses have implanted cardiac rhythm devices such as pacemakers and implantable cardioverter-defibrillators (ICDs). This study was conducted to identify potentially useful predictors of in-hospital cardiac arrest (I-HCA) within paced electrocardiogram (ECG) signals from cardiovascular patients with implanted medical devices. Methods:In this retrospective study of 17 subjects, full-disclosure ECG traces prior to the time of documented I-HCA were analyzed to determine R-R intervals and QRS durations (QRSd).Results: Ventricular paced QRSd prolongation was observed prior to I-HCA in 10/16 (63%) subjects. QRSd was significantly greater immediately preceding cardiac arrest than during each of the 8 hours prior to cardiac arrest (P < 0.05). Heart rate changes (measured using standard deviation) within 15 minutes of cardiac arrest were significantly greater in subjects with pulseless electrical activity (PEA)/asystolic arrest compared to those with cardiac arrests due to ventricular tachycardia/ventricular fibrillation (VT/VF) (10.13 vs 3.31; P = 0.024). Significant differences over the 8 hours preceding cardiac arrest in heart rate (74 vs 86 beats/min; P = 0.002) and QRS duration (172 ms vs 137 ms; P < 0.001) were observed between subjects with initial rhythms of VT/VF and those with initial rhythms of PEA/asystole.

An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac rehabilitation programs?

“…Overall, this study has an important clinical relevance as simple complications reported during the exercise sessions in cardiac rehabilitation programs may precede major complications. 14,15 Having effective measures able to predict the occurrence of simple complications may contribute to increase patient’s safety and help rehabilitation providers to anticipate the occurrence of major complications. Studies that investigate these aspects considered only some of the cardiac rehabilitation protocols available at the literature, important complications such as acute myocardial infarction, cardiorespiratory arrest and complex arrhythmias, 2,10–12 or a limited number of simple complications.…”

“…9 It suggests that those simple complications may happen even in a systematic cardiac rehabilitation programs, highlighting the importance of their identification and efficient management to avoid major problems. 14,15…”

“…Associations between the existing protocols and the occurrence of important complications such as death and cardiorespiratory arrest were already described. 14,15 Associations between those protocols and the occurrence of simple complications commonly observed in the cardiac rehabilitation setting remain unclear. Understanding this associations may be important to guarantee and increase patients’ safety while participating in cardiac rehabilitation programs.…”

Prognostic value of transient conduction disturbance in out‐of‐hospital cardiac arrest

“…It was also repeatedly indicated in other studies that prolongation of QRS duration during cardiac arrest might be associated with poor outcomes. 28,29 Considering these previous reports, we presumed the definition of the transient CD (DQRS duration of ≥18 ms) could be close to the preferable cut-off, then the definition might be reasonable.…”