Electrophysiological Deterioration During Long-Duration Ventricular Fibrillation

Tovar, Oscar H.; Jones, Janice L.

doi:10.1161/01.cir.102.23.2886

Cited by 32 publications

(23 citation statements)

References 24 publications

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“…Although this finding is not reflective of the higher proportion of VF/VT in our HD1 group, some episodes of PEA or a systole that were found may represent late detection of pulselessness and subsequent degeneration from a shockable arrest rhythm. 28 The absence of respiratory distress is consistent with our data in that lower rates of cardiac arrest due to ventilation were found in the first two hospital day groups.…”

Section: Discussionsupporting

confidence: 91%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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Objective Define the frequency and survival pattern of cardiac arrests in relation to the hospital day of event and etiology of arrest. Subject and methods Retrospective cohort study of adult in-hospital cardiac arrests between July 1, 2005, and June 30, 2013, that were classified by etiology of deterioration. Arrests were divided based on hospital day (HD) of event (HD1, HD2–7, HD>7 days), and analysis of frequency was performed. The primary outcome of survival to discharge and secondary outcomes of return of spontaneous circulation (ROSC) and favorable neurological outcomes were compared using multivariable logistic regression analysis. Results A total of 627 cases were included, 193 (30.8%) cases in group HD1, 206 (32.9%) in HD2–7, and 228 (36.4%) in HD>7. Etiology of arrest demonstrated variability across the groups (p < 0.001). Arrests due to ventilation issues increased in frequency with longer hospitalization (p < 0.001) while arrests due to dysrhythmia had the opposite trend (p = 0.014). Rates of survival to discharge (p = 0.038) and favorable neurological outcomes (p = 0.002) were lower with increasing hospital days while ROSC was not different among the groups (p = 0.183). Survival was highest for HD1 (HD1: 38.9% [95% CI, 32.0–45.7%], p = 0.002 vs HD2–7: 34.0% [95% CI, 27.5–40.4%], p < 0.001 vs HD>7: 27.2% [95% CI, 21.4–33.0%], p < 0.001). Conclusions The etiology of cardiac arrests varies in frequency as length of hospitalization increases. Survival rates and favorable neurological outcomes are lower for in-hospital arrests occurring later in the hospitalization, even when adjusted for age, sex, and location of event. Understanding these issues may help with focusing therapies and accurate prognostication.

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Section: Discussionsupporting

confidence: 91%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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“…33 Alternatively, some episodes of PEA or asystole may represent late detection of pulselessness, and shockable arrest rhythms may degenerate to PEA or asystole if cardiac arrest remains undetected. 34 In our study, most patients with IHCA on the ward in the setting of preexisting pneumonia had been PEA and asystole were the most common initial arrest rhythms in patients with preexisting pneumonia. We would expect these rhythms to have been common when arrests were preceded by shock, respiratory failure, and metabolic disarray.…”

Section: Discussionmentioning

confidence: 61%

Early Cardiac Arrest in Patients Hospitalized With Pneumonia

Carr

Yuen

McConville

et al. 2012

Chest

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“…Due to these limitations the results of these findings may not directly translate to humans. In spite of these limitations, the isolated rabbit heart model is widely used and well accepted for studying VF[37]–[39]. A final limitation is that we mapped only a small region of the VM near the His bundle and atrial tissue therefore there may be regions of faster VM activation that were not a measured.…”

Section: Discussionmentioning

confidence: 99%

His Bundle Activates Faster than Ventricular Myocardium during Prolonged Ventricular Fibrillation

Angel

Dosdall

2014

PLoS ONE

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BackgroundThe Purkinje fiber system has recently been implicated as an important driver of the rapid activation rate during long duration ventricular fibrillation (VF>2 minutes). The goal of this study is to determine whether this activity propagates to or occurs in the proximal specialized conduction system during VF as well.Methods and ResultsAn 8×8 array with 300 µm spaced electrodes was placed over the His bundles of isolated, perfused rabbit hearts (n = 12). Ventricular myocardial (VM) and His activations were differentiated by calculating Laplacian recordings from unipolar signals. Activation rates of the VM and His bundle were compared and the His bundle conduction velocity was measured during perfused VF followed by 8 minutes of unperfused VF. During perfused VF the average VM activation rate of 11.04 activations/sec was significantly higher than the His bundle activation rate of 6.88 activations/sec (p<0.05). However from 3–8 minutes of unperfused VF the His system activation rate (6.16, 5.53, 5.14, 5.22, 6.00, and 4.62 activations/sec significantly faster than the rate of the VM (4.67, 3.63, 2.94, 2.24, 3.45, and 2.31 activations/sec) (p<0.05). The conduction velocity of the His system immediately decreased to 94% of the sinus rate during perfused VF then gradually decreased to 67% of sinus rhythm conduction at 8 minutes of unperfused VF.ConclusionDuring prolonged VF the activation rate of the His bundle is faster than that of the VM. This suggests that the proximal conduction system, like the distal Purkinje system, may be an important driver during long duration VF and may be a target for interventional therapy.

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Electrophysiological Deterioration During Long-Duration Ventricular Fibrillation

Cited by 32 publications

References 24 publications

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Early Cardiac Arrest in Patients Hospitalized With Pneumonia

His Bundle Activates Faster than Ventricular Myocardium during Prolonged Ventricular Fibrillation

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